- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.41 / $364.71 / $1,705.05
| Professional | | $326.41 | $364.71 | $1,705.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.78 / $604.46 / $1,190.64
| Professional | | $512.78 | $604.46 | $1,190.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.50 / $517.55 / $583.05
| Professional | | $293.50 | $517.55 | $583.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.22 / $485.10 / $582.53
| Professional | | $287.22 | $485.10 | $582.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.85 / $444.15 / $1,347.06
| Professional | | $369.85 | $444.15 | $1,347.06 |