- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.14 / $732.67 / $1,018.96
| Professional | | $593.14 | $732.67 | $1,018.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.91 / $953.98 / $1,378.44
| Professional | | $578.91 | $953.98 | $1,378.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $129.19 / $1,076.67
| Professional | | $32.34 | $129.19 | $1,076.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.67 / $1,032.03 / $1,662.57
| Professional | | $685.67 | $1,032.03 | $1,662.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.52 / $1,121.50 / $1,798.20
| Professional | | $787.52 | $1,121.50 | $1,798.20 |