- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.11 / $402.87 / $504.24
| Professional | | $317.11 | $402.87 | $504.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.70 / $922.58 / $1,109.29
| Professional | | $716.70 | $922.58 | $1,109.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.27 / $947.94 / $1,502.14
| Professional | | $675.27 | $947.94 | $1,502.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.26 / $890.71 / $3,541.36
| Professional | | $492.26 | $890.71 | $3,541.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.66 / $748.91 / $1,257.13
| Professional | | $484.66 | $748.91 | $1,257.13 |