- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.98 / $532.09 / $2,459.37
| Professional | | $467.98 | $532.09 | $2,459.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.72 / $743.48 / $1,668.14
| Professional | | $630.72 | $743.48 | $1,668.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.21 / $719.85 / $855.39
| Professional | | $424.21 | $719.85 | $855.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.21 / $681.97 / $855.39
| Professional | | $424.21 | $681.97 | $855.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.97 / $629.71 / $1,911.10
| Professional | | $520.97 | $629.71 | $1,911.10 |