- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.22 / $655.91 / $1,182.85
| Professional | | $429.22 | $655.91 | $1,182.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.61 / $530.61 / $736.47
| Professional | | $530.61 | $530.61 | $736.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.62 / $613.84 / $945.92
| Professional | | $401.62 | $613.84 | $945.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.67 / $691.98 / $3,604.00
| Professional | | $553.67 | $691.98 | $3,604.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.59 / $691.98 / $976.38
| Professional | | $536.59 | $691.98 | $976.38 |