- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.16 / $226.83 / $1,101.27
| Professional | | $160.16 | $226.83 | $1,101.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.52 / $319.37 / $667.80
| Professional | | $181.52 | $319.37 | $667.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.28 / $678.60 / $1,352.40
| Professional | | $405.28 | $678.60 | $1,352.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.06 / $830.30 / $1,282.50
| Professional | | $478.06 | $830.30 | $1,282.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.68 / $658.50 / $1,190.00
| Professional | | $243.68 | $658.50 | $1,190.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.31 / $537.60 / $1,482.88
| Professional | | $274.31 | $537.60 | $1,482.88 |