- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.46 / $997.55 / $1,405.64
| Professional | | $480.46 | $997.55 | $1,405.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.15 / $916.98 / $1,223.05
| Professional | | $772.15 | $916.98 | $1,223.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.04 / $528.40 / $1,671.15
| Professional | | $423.04 | $528.40 | $1,671.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.45 / $563.74 / $1,671.15
| Professional | | $353.45 | $563.74 | $1,671.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.22 / $1,317.42 / $1,501.16
| Professional | | $463.22 | $1,317.42 | $1,501.16 |