- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $1,148.15
| Professional | | $426.58 | $645.65 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $2,137.96
| Professional | | $676.08 | $794.33 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $776.25 / $1,023.29
| Professional | | $478.63 | $776.25 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $2,137.96
| Professional | | $977.24 | $977.24 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $660.69 / $1,905.46
| Professional | | $489.78 | $660.69 | $1,905.46 |