- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.63 / $384.20 / $604.07
| Professional | | $273.63 | $384.20 | $604.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.11 / $624.88 / $1,831.25
| Professional | | $530.11 | $624.88 | $1,831.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.90 / $611.32 / $1,099.02
| Professional | | $416.90 | $611.32 | $1,099.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.35 / $628.72 / $1,099.02
| Professional | | $430.35 | $628.72 | $1,099.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.22 / $679.04 / $1,157.73
| Professional | | $562.22 | $679.04 | $1,157.73 |