- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.76 / $753.17 / $3,371.46
| Professional | | $604.76 | $753.17 | $3,371.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.54 / $747.19 / $1,078.30
| Professional | | $647.54 | $747.19 | $1,078.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.91 / $852.74 / $1,310.04
| Professional | | $543.91 | $852.74 | $1,310.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $825.22 / $3,001.38
| Professional | | $16.93 | $825.22 | $3,001.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.52 / $744.35 / $4,739.03
| Professional | | $11.52 | $744.35 | $4,739.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.41 / $843.50 / $1,301.11
| Professional | | $638.41 | $843.50 | $1,301.11 |