- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.77 / $770.60 / $1,084.31
| Professional | | $596.77 | $770.60 | $1,084.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.84 / $1,061.00 / $1,223.60
| Professional | | $833.84 | $1,061.00 | $1,223.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.63 / $904.67 / $967.82
| Professional | | $785.63 | $904.67 | $967.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $146.43 / $760.34
| Professional | | $32.34 | $146.43 | $760.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.96 / $764.66 / $937.91
| Professional | | $649.96 | $764.66 | $937.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.01 / $922.74 / $1,252.56
| Professional | | $698.01 | $922.74 | $1,252.56 |