- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.92 / $623.84 / $2,446.17
| Professional | | $461.92 | $623.84 | $2,446.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.01 / $802.76 / $2,139.92
| Professional | | $681.01 | $802.76 | $2,139.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.77 / $796.21 / $1,028.66
| Professional | | $481.77 | $796.21 | $1,028.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.28 / $776.98 / $1,019.79
| Professional | | $422.28 | $776.98 | $1,019.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.79 / $705.18 / $2,414.39
| Professional | | $617.79 | $705.18 | $2,414.39 |