- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.80 / $848.35 / $1,301.63
| Professional | | $480.80 | $848.35 | $1,301.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.27 / $616.75 / $947.98
| Professional | | $427.27 | $616.75 | $947.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.47 / $765.96 / $1,028.30
| Professional | | $574.47 | $765.96 | $1,028.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,030.77
| Professional | | $32.34 | $32.34 | $1,030.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.21 / $976.14 / $1,201.03
| Professional | | $642.21 | $976.14 | $1,201.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.99 / $785.46 / $1,085.03
| Professional | | $528.99 | $785.46 | $1,085.03 |