- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.18 / $604.45 / $2,759.37
| Professional | | $511.18 | $604.45 | $2,759.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.38 / $583.65 / $666.80
| Professional | | $583.38 | $583.65 | $666.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.20 / $707.05 / $1,644.69
| Professional | | $486.20 | $707.05 | $1,644.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.74 / $723.17 / $1,155.98
| Professional | | $543.74 | $723.17 | $1,155.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.80 / $623.46 / $1,127.66
| Professional | | $450.80 | $623.46 | $1,127.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.95 / $625.29 / $776.96
| Professional | | $436.95 | $625.29 | $776.96 |