- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.14 / $611.88 / $614.95
| Professional | | $441.14 | $611.88 | $614.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.19 / $913.78 / $1,873.27
| Professional | | $775.19 | $913.78 | $1,873.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.58 / $878.15 / $1,156.63
| Professional | | $588.58 | $878.15 | $1,156.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.58 / $765.02 / $1,156.63
| Professional | | $588.58 | $765.02 | $1,156.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.61 / $726.46 / $2,111.87
| Professional | | $631.61 | $726.46 | $2,111.87 |