- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.85 / $631.04 / $825.83
| Professional | | $521.85 | $631.04 | $825.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.52 / $979.01 / $1,858.20
| Professional | | $830.52 | $979.01 | $1,858.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.82 / $830.56 / $1,061.94
| Professional | | $563.82 | $830.56 | $1,061.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.00 / $810.00 / $1,061.94
| Professional | | $535.00 | $810.00 | $1,061.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.27 / $824.60 / $2,131.53
| Professional | | $502.27 | $824.60 | $2,131.53 |