- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.37 / $1,001.32 / $1,362.52
| Professional | | $212.37 | $1,001.32 | $1,362.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.98 / $488.21 / $913.26
| Professional | | $362.98 | $488.21 | $913.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.48 / $590.97 / $828.72
| Professional | | $492.48 | $590.97 | $828.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.40 / $883.05 / $1,216.50
| Professional | | $486.40 | $883.05 | $1,216.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.32 / $753.75 / $1,447.04
| Professional | | $363.32 | $753.75 | $1,447.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.66 / $730.60 / $1,102.19
| Professional | | $306.66 | $730.60 | $1,102.19 |