- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.12 / $621.13 / $657.03
| Professional | | $453.12 | $621.13 | $657.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.51 / $933.02 / $1,900.84
| Professional | | $791.51 | $933.02 | $1,900.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.45 / $821.93 / $1,181.05
| Professional | | $572.45 | $821.93 | $1,181.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.29 / $781.25 / $1,181.05
| Professional | | $545.29 | $781.25 | $1,181.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.00 / $741.80 / $2,156.48
| Professional | | $591.00 | $741.80 | $2,156.48 |