- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $616.60 / $1,148.15
| Professional | | $398.11 | $616.60 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $1,258.93
| Professional | | $478.63 | $794.33 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $758.58 / $1,548.82
| Professional | | $363.08 | $758.58 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $933.25
| Professional | | $467.74 | $776.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $588.84 / $1,230.27
| Professional | | $363.08 | $588.84 | $1,230.27 |