- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.69 / $528.44 / $1,371.38
| Professional | | $404.69 | $528.44 | $1,371.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.94 / $629.67 / $855.83
| Professional | | $437.94 | $629.67 | $855.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $299.50 / $789.47
| Professional | | $32.34 | $299.50 | $789.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.50 / $690.03 / $1,019.92
| Professional | | $440.50 | $690.03 | $1,019.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.67 / $846.18 / $1,018.54
| Professional | | $566.67 | $846.18 | $1,018.54 |