- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.02 / $504.48 / $1,898.72
| Professional | | $330.02 | $504.48 | $1,898.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.94 / $591.72 / $992.79
| Professional | | $419.94 | $591.72 | $992.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.16 / $315.37 / $523.85
| Professional | | $61.16 | $315.37 | $523.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.24 / $765.32 / $1,164.20
| Professional | | $488.24 | $765.32 | $1,164.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.10 / $553.89 / $877.29
| Professional | | $449.10 | $553.89 | $877.29 |