- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $562.34 / $1,023.29
| Professional | | $380.19 | $562.34 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $2,884.03 / $7,079.46
| Professional | | $371.54 | $2,884.03 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $562.34 / $1,621.81
| Professional | | $371.54 | $562.34 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $912.01 / $1,412.54
| Professional | | $676.08 | $912.01 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $549.54 / $1,258.93
| Professional | | $309.03 | $549.54 | $1,258.93 |