- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.12 / $550.71 / $1,301.63
| Professional | | $412.12 | $550.71 | $1,301.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.17 / $613.84 / $1,000.77
| Professional | | $407.17 | $613.84 | $1,000.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.37 / $339.63 / $543.42
| Professional | | $29.37 | $339.63 | $543.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.66 / $794.70 / $1,049.98
| Professional | | $551.66 | $794.70 | $1,049.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.88 / $572.90 / $838.44
| Professional | | $474.88 | $572.90 | $838.44 |