- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.32 / $618.22 / $2,453.55
| Professional | | $398.32 | $618.22 | $2,453.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.72 / $405.10 / $540.14
| Professional | | $359.72 | $405.10 | $540.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.54 / $508.60 / $1,024.64
| Professional | | $344.54 | $508.60 | $1,024.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.60 / $575.40 / $4,474.16
| Professional | | $444.60 | $575.40 | $4,474.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.25 / $555.46 / $1,116.35
| Professional | | $432.25 | $555.46 | $1,116.35 |