- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $630.96 / $1,023.29
| Professional | | $512.86 | $630.96 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $776.25 / $1,412.54
| Professional | | $489.78 | $776.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $416.87 / $724.44
| Professional | | $275.42 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $331.13 / $812.83
| Professional | | $32.36 | $331.13 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $1,202.26
| Professional | | $478.63 | $660.69 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $537.03
| Professional | | $380.19 | $380.19 | $537.03 |