- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.94 / $589.78 / $1,017.34
| Professional | | $492.94 | $589.78 | $1,017.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.07 / $564.35 / $863.45
| Professional | | $474.07 | $564.35 | $863.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.90 / $116.05 / $652.04
| Professional | | $82.90 | $116.05 | $652.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.04 / $816.36 / $1,208.44
| Professional | | $491.04 | $816.36 | $1,208.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $135.47 / $341.87
| Professional | | $32.34 | $135.47 | $341.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.30 / $760.18 / $1,232.63
| Professional | | $548.30 | $760.18 | $1,232.63 |