- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.92 / $453.58 / $580.30
| Professional | | $369.92 | $453.58 | $580.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.57 / $1,035.82 / $1,245.43
| Professional | | $822.57 | $1,035.82 | $1,245.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.96 / $1,065.90 / $1,683.58
| Professional | | $734.96 | $1,065.90 | $1,683.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.05 / $1,003.07 / $5,098.60
| Professional | | $555.05 | $1,003.07 | $5,098.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.13 / $828.63 / $1,171.50
| Professional | | $547.13 | $828.63 | $1,171.50 |