- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.32 / $438.88 / $648.58
| Professional | | $313.32 | $438.88 | $648.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.20 / $818.31 / $1,971.20
| Professional | | $694.20 | $818.31 | $1,971.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.04 / $730.01 / $1,256.09
| Professional | | $487.04 | $730.01 | $1,256.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.97 / $750.50 / $1,256.09
| Professional | | $497.97 | $750.50 | $1,256.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.41 / $788.93 / $2,293.46
| Professional | | $599.41 | $788.93 | $2,293.46 |