- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.15 / $623.04 / $1,062.18
| Professional | | $525.15 | $623.04 | $1,062.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.04 / $1,138.68 / $1,274.07
| Professional | | $947.04 | $1,138.68 | $1,274.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.52 / $1,032.27 / $1,298.00
| Professional | | $655.52 | $1,032.27 | $1,298.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.75 / $1,214.40 / $4,283.07
| Professional | | $690.75 | $1,214.40 | $4,283.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.77 / $1,190.43 / $1,487.92
| Professional | | $664.77 | $1,190.43 | $1,487.92 |