- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.97 / $452.12 / $627.16
| Professional | | $317.97 | $452.12 | $627.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.61 / $777.53 / $1,901.61
| Professional | | $659.61 | $777.53 | $1,901.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.47 / $699.00 / $1,203.15
| Professional | | $483.47 | $699.00 | $1,203.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.54 / $729.78 / $1,203.15
| Professional | | $502.54 | $729.78 | $1,203.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.85 / $743.37 / $2,196.81
| Professional | | $581.85 | $743.37 | $2,196.81 |