- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.47 / $648.38 / $3,111.85
| Professional | | $417.47 | $648.38 | $3,111.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.52 / $615.07 / $990.05
| Professional | | $356.52 | $615.07 | $990.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $499.24 / $1,123.29
| Professional | | $32.34 | $499.24 | $1,123.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.52 / $614.16 / $950.12
| Professional | | $356.52 | $614.16 | $950.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.62 / $772.67 / $1,156.95
| Professional | | $545.62 | $772.67 | $1,156.95 |