- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.71 / $627.28 / $873.37
| Professional | | $505.71 | $627.28 | $873.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.96 / $447.95 / $559.94
| Professional | | $335.96 | $447.95 | $559.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.04 / $831.08 / $1,435.35
| Professional | | $537.04 | $831.08 | $1,435.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.02 / $729.12 / $4,283.07
| Professional | | $571.02 | $729.12 | $4,283.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.52 / $664.77 / $1,314.11
| Professional | | $555.52 | $664.77 | $1,314.11 |