- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.15 / $402.67 / $576.21
| Professional | | $214.15 | $402.67 | $576.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.30 / $606.26 / $1,700.07
| Professional | | $514.30 | $606.26 | $1,700.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.29 / $497.57 / $1,079.26
| Professional | | $328.29 | $497.57 | $1,079.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.16 / $588.08 / $1,079.26
| Professional | | $341.16 | $588.08 | $1,079.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.28 / $666.83 / $1,970.60
| Professional | | $466.28 | $666.83 | $1,970.60 |