- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.08 / $669.85 / $1,027.96
| Professional | | $460.08 | $669.85 | $1,027.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.40 / $894.40 / $1,543.13
| Professional | | $894.40 | $894.40 | $1,543.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.35 / $145.35 / $145.35
| Professional | | $145.35 | $145.35 | $145.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.69 / $1,063.17 / $1,117.64
| Professional | | $903.69 | $1,063.17 | $1,117.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.55 / $797.38 / $1,175.95
| Professional | | $589.55 | $797.38 | $1,175.95 |