- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.14 / $799.13 / $1,613.70
| Professional | | $620.14 | $799.13 | $1,613.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.52 / $894.18 / $1,324.39
| Professional | | $396.52 | $894.18 | $1,324.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.57 / $1,029.25 / $1,425.12
| Professional | | $643.57 | $1,029.25 | $1,425.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $133.27 / $1,182.26
| Professional | | $32.34 | $133.27 | $1,182.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.69 / $1,094.06 / $1,654.51
| Professional | | $707.69 | $1,094.06 | $1,654.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.30 / $1,201.41 / $1,832.41
| Professional | | $867.30 | $1,201.41 | $1,832.41 |