- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.10 / $472.16 / $2,924.65
| Professional | | $374.10 | $472.16 | $2,924.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.65 / $675.65 / $848.12
| Professional | | $675.65 | $675.65 | $848.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.55 / $718.77 / $912.58
| Professional | | $540.55 | $718.77 | $912.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.90 / $728.65 / $1,018.03
| Professional | | $509.90 | $728.65 | $1,018.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.08 / $908.85 / $993.15
| Professional | | $798.08 | $908.85 | $993.15 |