- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.52 / $922.14 / $3,246.76
| Professional | | $570.52 | $922.14 | $3,246.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.69 / $965.44 / $1,463.52
| Professional | | $707.69 | $965.44 | $1,463.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.08 / $468.82 / $738.47
| Professional | | $91.08 | $468.82 | $738.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.07 / $1,177.07 / $1,985.53
| Professional | | $795.07 | $1,177.07 | $1,985.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.10 / $839.08 / $1,355.23
| Professional | | $689.10 | $839.08 | $1,355.23 |