- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.01 / $439.08 / $1,863.37
| Professional | | $328.01 | $439.08 | $1,863.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.62 / $624.74 / $884.65
| Professional | | $350.62 | $624.74 | $884.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.98 / $1,043.66 / $1,404.94
| Professional | | $391.98 | $1,043.66 | $1,404.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.96 / $991.87 / $3,541.36
| Professional | | $562.96 | $991.87 | $3,541.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.54 / $932.58 / $1,271.84
| Professional | | $636.54 | $932.58 | $1,271.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.96 / $1,031.01 / $1,134.14
| Professional | | $562.96 | $1,031.01 | $1,134.14 |