- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.63 / $479.02 / $520.27
| Professional | | $427.63 | $479.02 | $520.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.82 / $727.08 / $1,615.16
| Professional | | $616.82 | $727.08 | $1,615.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.41 / $684.43 / $974.46
| Professional | | $443.41 | $684.43 | $974.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.84 / $644.34 / $974.46
| Professional | | $530.84 | $644.34 | $974.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.70 / $612.04 / $1,779.24
| Professional | | $508.70 | $612.04 | $1,779.24 |