- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.56 / $467.41 / $1,992.15
| Professional | | $369.56 | $467.41 | $1,992.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.31 / $320.45 / $398.79
| Professional | | $262.31 | $320.45 | $398.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.91 / $493.07 / $868.51
| Professional | | $340.91 | $493.07 | $868.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.66 / $608.40 / $3,128.96
| Professional | | $421.66 | $608.40 | $3,128.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.10 / $513.76 / $894.76
| Professional | | $416.10 | $513.76 | $894.76 |