- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.25 / $455.77 / $631.24
| Professional | | $322.25 | $455.77 | $631.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.69 / $800.03 / $1,916.86
| Professional | | $678.69 | $800.03 | $1,916.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.55 / $709.34 / $1,202.29
| Professional | | $482.55 | $709.34 | $1,202.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.61 / $729.37 / $1,202.29
| Professional | | $497.61 | $729.37 | $1,202.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.47 / $742.85 / $2,195.26
| Professional | | $559.47 | $742.85 | $2,195.26 |