- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $645.65 / $1,047.13
| Professional | | $537.03 | $645.65 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,148.15
| Professional | | $467.74 | $676.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,412.54
| Professional | | $602.56 | $831.76 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $676.08 / $2,344.23
| Professional | | $549.54 | $676.08 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $660.69 / $912.01
| Professional | | $114.82 | $660.69 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $1,318.26
| Professional | | $575.44 | $812.83 | $1,318.26 |