- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.18 / $613.64 / $793.07
| Professional | | $438.18 | $613.64 | $793.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.02 / $879.40 / $2,140.77
| Professional | | $746.02 | $879.40 | $2,140.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.89 / $878.86 / $1,363.93
| Professional | | $582.89 | $878.86 | $1,363.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.91 / $850.30 / $1,363.93
| Professional | | $611.91 | $850.30 | $1,363.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.19 / $856.66 / $2,490.37
| Professional | | $761.19 | $856.66 | $2,490.37 |