- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $1,202.26
| Professional | | $398.11 | $524.81 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $1,698.24
| Professional | | $660.69 | $660.69 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $645.65 / $1,047.13
| Professional | | $371.54 | $645.65 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $794.33
| Professional | | $489.78 | $630.96 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $1,905.46
| Professional | | $549.54 | $660.69 | $1,905.46 |