- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.68 / $533.22 / $1,296.58
| Professional | | $376.68 | $533.22 | $1,296.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.98 / $602.42 / $881.61
| Professional | | $382.98 | $602.42 | $881.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.02 / $873.61 / $1,431.92
| Professional | | $524.02 | $873.61 | $1,431.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.53 / $954.51 / $2,015.89
| Professional | | $527.53 | $954.51 | $2,015.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.46 / $884.38 / $1,712.45
| Professional | | $734.46 | $884.38 | $1,712.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.19 / $437.07 / $555.14
| Professional | | $312.19 | $437.07 | $555.14 |