- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.72 / $805.55 / $1,099.98
| Professional | | $390.72 | $805.55 | $1,099.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.71 / $698.97 / $829.29
| Professional | | $362.71 | $698.97 | $829.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.75 / $681.28 / $1,137.58
| Professional | | $480.75 | $681.28 | $1,137.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.45 / $710.16 / $710.16
| Professional | | $671.45 | $710.16 | $710.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.00 / $759.41 / $1,344.73
| Professional | | $462.00 | $759.41 | $1,344.73 |