- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.74 / $563.92 / $1,180.43
| Professional | | $120.74 | $563.92 | $1,180.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.88 / $382.88 / $766.19
| Professional | | $382.88 | $382.88 | $766.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.43 / $806.80 / $1,661.10
| Professional | | $324.43 | $806.80 | $1,661.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.45 / $751.51 / $1,381.43
| Professional | | $495.45 | $751.51 | $1,381.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.30 / $650.30 / $1,381.43
| Professional | | $257.30 | $650.30 | $1,381.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.05 / $612.96 / $1,272.04
| Professional | | $553.05 | $612.96 | $1,272.04 |