- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.66 / $691.98 / $3,189.89
| Professional | | $496.66 | $691.98 | $3,189.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.64 / $869.51 / $2,160.34
| Professional | | $737.64 | $869.51 | $2,160.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.14 / $934.69 / $1,114.06
| Professional | | $551.14 | $934.69 | $1,114.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.79 / $885.15 / $1,114.06
| Professional | | $512.79 | $885.15 | $1,114.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.17 / $784.26 / $2,480.52
| Professional | | $669.17 | $784.26 | $2,480.52 |