- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.20 / $472.02 / $794.51
| Professional | | $296.20 | $472.02 | $794.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.97 / $633.04 / $1,849.37
| Professional | | $520.97 | $633.04 | $1,849.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.11 / $640.92 / $1,818.52
| Professional | | $395.11 | $640.92 | $1,818.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.08 / $703.67 / $1,818.52
| Professional | | $431.08 | $703.67 | $1,818.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.99 / $566.88 / $2,006.22
| Professional | | $501.99 | $566.88 | $2,006.22 |