- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $1,202.26
| Professional | | $549.54 | $660.69 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $588.84 / $2,630.27
| Professional | | $489.78 | $588.84 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $977.24 / $1,737.80
| Professional | | $630.96 | $977.24 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $660.69 / $1,412.54
| Professional | | $562.34 | $660.69 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,148.15 / $1,584.89
| Professional | | $537.03 | $1,148.15 | $1,584.89 |