- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.63 / $667.03 / $683.13
| Professional | | $477.63 | $667.03 | $683.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.78 / $985.19 / $2,078.55
| Professional | | $835.78 | $985.19 | $2,078.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.02 / $936.04 / $1,286.81
| Professional | | $633.02 | $936.04 | $1,286.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.11 / $853.53 / $1,286.81
| Professional | | $595.11 | $853.53 | $1,286.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.86 / $795.06 / $2,349.55
| Professional | | $680.86 | $795.06 | $2,349.55 |