- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $758.58 / $1,621.81
| Professional | | $562.34 | $758.58 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,148.15
| Professional | | $977.24 | $977.24 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $1,412.54
| Professional | | $549.54 | $870.96 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $870.96 / $1,047.13
| Professional | | $660.69 | $870.96 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $891.25 / $2,570.40
| Professional | | $741.31 | $891.25 | $2,570.40 |