- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.56 / $565.09 / $847.64
| Professional | | $370.56 | $565.09 | $847.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.76 / $613.23 / $1,214.94
| Professional | | $379.76 | $613.23 | $1,214.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.16 / $569.66 / $1,007.82
| Professional | | $377.16 | $569.66 | $1,007.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,604.00 / $4,474.16 / $4,966.20
| Professional | | $3,604.00 | $4,474.16 | $4,966.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.49 / $622.98 / $1,148.50
| Professional | | $495.49 | $622.98 | $1,148.50 |