- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.29 / $529.29 / $591.24
| Professional | | $529.29 | $529.29 | $591.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.93 / $781.45 / $1,814.50
| Professional | | $662.93 | $781.45 | $1,814.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.77 / $755.15 / $1,054.57
| Professional | | $537.77 | $755.15 | $1,054.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.98 / $697.37 / $1,054.57
| Professional | | $483.98 | $697.37 | $1,054.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.67 / $662.35 / $1,925.51
| Professional | | $542.67 | $662.35 | $1,925.51 |