- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.29 / $476.41 / $1,280.15
| Professional | | $440.29 | $476.41 | $1,280.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.16 / $596.42 / $704.58
| Professional | | $559.16 | $596.42 | $704.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.55 / $656.24 / $1,247.56
| Professional | | $455.55 | $656.24 | $1,247.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.82 / $672.74 / $1,070.14
| Professional | | $505.82 | $672.74 | $1,070.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.05 / $567.99 / $1,000.79
| Professional | | $437.05 | $567.99 | $1,000.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.67 / $581.69 / $703.29
| Professional | | $477.67 | $581.69 | $703.29 |