- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.38 / $473.73 / $644.94
| Professional | | $339.38 | $473.73 | $644.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.34 / $954.03 / $1,919.21
| Professional | | $809.34 | $954.03 | $1,919.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.52 / $698.47 / $1,206.46
| Professional | | $514.52 | $698.47 | $1,206.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.63 / $730.63 / $1,206.46
| Professional | | $533.63 | $730.63 | $1,206.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.19 / $757.76 / $2,202.87
| Professional | | $643.19 | $757.76 | $2,202.87 |