- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.09 / $714.37 / $1,044.84
| Professional | | $545.09 | $714.37 | $1,044.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.60 / $711.32 / $1,419.94
| Professional | | $450.60 | $711.32 | $1,419.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.27 / $1,022.41 / $1,941.31
| Professional | | $714.27 | $1,022.41 | $1,941.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.77 / $832.13 / $1,385.00
| Professional | | $576.77 | $832.13 | $1,385.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.77 / $1,081.61 / $1,815.12
| Professional | | $664.77 | $1,081.61 | $1,815.12 |