- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.74 / $701.62 / $1,411.77
| Professional | | $455.74 | $701.62 | $1,411.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.35 / $543.20 / $1,377.11
| Professional | | $251.35 | $543.20 | $1,377.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.33 / $748.58 / $1,272.40
| Professional | | $280.33 | $748.58 | $1,272.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.14 / $404.56 / $1,131.49
| Professional | | $239.14 | $404.56 | $1,131.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.42 / $544.19 / $1,040.54
| Professional | | $311.42 | $544.19 | $1,040.54 |