- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $891.25
| Professional | | $398.11 | $562.34 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $676.08 / $1,047.13
| Professional | | $354.81 | $676.08 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $1,445.44
| Professional | | $524.81 | $891.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $831.76 / $1,659.59
| Professional | | $467.74 | $831.76 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $794.33 / $1,698.24
| Professional | | $467.74 | $794.33 | $1,698.24 |