- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $660.69 / $1,174.90
| Professional | | $426.58 | $660.69 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $2,398.83
| Professional | | $851.14 | $851.14 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $831.76 / $1,174.90
| Professional | | $489.78 | $831.76 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $933.25 / $1,096.48
| Professional | | $691.83 | $933.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $794.33 / $1,584.89
| Professional | | $616.60 | $794.33 | $1,584.89 |