- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.62 / $585.97 / $975.69
| Professional | | $428.62 | $585.97 | $975.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.36 / $1,099.05 / $2,193.38
| Professional | | $932.36 | $1,099.05 | $2,193.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.19 / $815.91 / $1,054.42
| Professional | | $527.19 | $815.91 | $1,054.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.19 / $815.91 / $1,054.42
| Professional | | $527.19 | $815.91 | $1,054.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.28 / $845.81 / $2,476.78
| Professional | | $724.28 | $845.81 | $2,476.78 |