- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $1,096.48
| Professional | | $346.74 | $467.74 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $512.86 / $794.33
| Professional | | $380.19 | $512.86 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $676.08
| Professional | | $363.08 | $524.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $588.84 / $1,023.29
| Professional | | $416.87 | $588.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $5,128.61
| Professional | | $478.63 | $741.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $870.96
| Professional | | $363.08 | $524.81 | $870.96 |