- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.48 / $540.54 / $1,004.00
| Professional | | $359.48 | $540.54 | $1,004.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.44 / $570.20 / $767.28
| Professional | | $393.44 | $570.20 | $767.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.61 / $682.67 / $1,103.29
| Professional | | $442.61 | $682.67 | $1,103.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.62 / $700.73 / $732.01
| Professional | | $595.62 | $700.73 | $732.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.95 / $666.07 / $1,122.98
| Professional | | $481.95 | $666.07 | $1,122.98 |