- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.82 / $685.98 / $1,022.09
| Professional | | $579.82 | $685.98 | $1,022.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.00 / $861.00 / $861.00
| Professional | | $861.00 | $861.00 | $861.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.33 / $835.73 / $1,083.78
| Professional | | $485.33 | $835.73 | $1,083.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $372.09
| Professional | | $32.34 | $32.34 | $372.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.66 / $710.13 / $1,003.90
| Professional | | $573.66 | $710.13 | $1,003.90 |