- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.18 / $506.33 / $776.47
| Professional | | $352.18 | $506.33 | $776.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.75 / $613.22 / $1,003.25
| Professional | | $364.75 | $613.22 | $1,003.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.92 / $570.17 / $1,032.36
| Professional | | $433.92 | $570.17 | $1,032.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,144.91 / $2,144.91 / $2,144.91
| Professional | | $2,144.91 | $2,144.91 | $2,144.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.06 / $380.42 / $708.72
| Professional | | $75.06 | $380.42 | $708.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.76 / $568.73 / $1,199.36
| Professional | | $422.76 | $568.73 | $1,199.36 |