- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.51 / $1,047.89 / $1,955.07
| Professional | | $838.51 | $1,047.89 | $1,955.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.69 / $1,007.34 / $1,720.10
| Professional | | $761.69 | $1,007.34 | $1,720.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.98 / $581.70 / $771.26
| Professional | | $54.98 | $581.70 | $771.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.31 / $1,228.04 / $1,517.51
| Professional | | $987.31 | $1,228.04 | $1,517.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.26 / $943.21 / $1,886.41
| Professional | | $795.26 | $943.21 | $1,886.41 |