- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.68 / $749.50 / $1,214.25
| Professional | | $486.68 | $749.50 | $1,214.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.37 / $962.32 / $2,740.10
| Professional | | $816.37 | $962.32 | $2,740.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.19 / $930.70 / $1,304.50
| Professional | | $564.19 | $930.70 | $1,304.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.19 / $924.47 / $1,304.50
| Professional | | $564.19 | $924.47 | $1,304.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.84 / $936.37 / $3,120.96
| Professional | | $773.84 | $936.37 | $3,120.96 |