- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.17 / $331.37 / $1,894.04
| Professional | | $254.17 | $331.37 | $1,894.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.27 / $423.27 / $561.03
| Professional | | $423.27 | $423.27 | $561.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.78 / $471.42 / $590.73
| Professional | | $359.78 | $471.42 | $590.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.67 / $476.88 / $665.27
| Professional | | $334.67 | $476.88 | $665.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.01 / $600.62 / $654.32
| Professional | | $539.01 | $600.62 | $654.32 |