- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.42 / $432.09 / $2,250.41
| Professional | | $416.42 | $432.09 | $2,250.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.57 / $535.57 / $1,506.97
| Professional | | $535.57 | $535.57 | $1,506.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.27 / $704.41 / $1,506.97
| Professional | | $340.27 | $704.41 | $1,506.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.70 / $698.76 / $1,506.97
| Professional | | $444.70 | $698.76 | $1,506.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.92 / $603.62 / $1,754.78
| Professional | | $451.92 | $603.62 | $1,754.78 |