- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.31 / $437.66 / $600.10
| Professional | | $313.31 | $437.66 | $600.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.08 / $610.51 / $1,819.89
| Professional | | $505.08 | $610.51 | $1,819.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.25 / $652.50 / $1,106.34
| Professional | | $465.25 | $652.50 | $1,106.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.78 / $652.48 / $1,106.34
| Professional | | $496.78 | $652.48 | $1,106.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.07 / $683.56 / $2,020.05
| Professional | | $557.07 | $683.56 | $2,020.05 |