- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.53 / $455.64 / $934.06
| Professional | | $363.53 | $455.64 | $934.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.08 / $1,043.04 / $3,196.27
| Professional | | $859.08 | $1,043.04 | $3,196.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.23 / $525.08 / $1,284.66
| Professional | | $393.23 | $525.08 | $1,284.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.85 / $653.15 / $1,284.66
| Professional | | $477.85 | $653.15 | $1,284.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.11 / $633.49 / $1,841.59
| Professional | | $475.11 | $633.49 | $1,841.59 |