- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.60 / $670.48 / $1,001.03
| Professional | | $537.60 | $670.48 | $1,001.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.82 / $534.17 / $812.08
| Professional | | $440.82 | $534.17 | $812.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.41 / $774.75 / $1,098.94
| Professional | | $604.41 | $774.75 | $1,098.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.62 / $935.22 / $1,530.73
| Professional | | $603.62 | $935.22 | $1,530.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $914.56
| Professional | | $32.34 | $32.34 | $914.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.01 / $969.58 / $1,589.37
| Professional | | $688.01 | $969.58 | $1,589.37 |