- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.12 / $714.37 / $1,084.31
| Professional | | $474.12 | $714.37 | $1,084.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.30 / $128.30 / $808.15
| Professional | | $128.30 | $128.30 | $808.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.47 / $727.34 / $1,164.19
| Professional | | $566.47 | $727.34 | $1,164.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.79 / $907.89 / $1,547.16
| Professional | | $613.79 | $907.89 | $1,547.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.16 / $1,068.35 / $1,252.56
| Professional | | $884.16 | $1,068.35 | $1,252.56 |