- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.02 / $497.46 / $730.70
| Professional | | $408.02 | $497.46 | $730.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.16 / $444.54 / $658.42
| Professional | | $338.16 | $444.54 | $658.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.00 / $606.35 / $1,581.77
| Professional | | $370.00 | $606.35 | $1,581.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.35 / $757.80 / $4,474.16
| Professional | | $494.35 | $757.80 | $4,474.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.21 / $666.55 / $1,153.30
| Professional | | $494.21 | $666.55 | $1,153.30 |