- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.12 / $510.56 / $1,125.48
| Professional | | $323.12 | $510.56 | $1,125.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.80 / $648.33 / $936.36
| Professional | | $374.80 | $648.33 | $936.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.55 / $739.36 / $1,248.84
| Professional | | $535.55 | $739.36 | $1,248.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.90 / $678.74 / $906.64
| Professional | | $457.90 | $678.74 | $906.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.22 / $898.27 / $1,490.83
| Professional | | $459.22 | $898.27 | $1,490.83 |