- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.09 / $767.23 / $881.68
| Professional | | $615.09 | $767.23 | $881.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.33 / $1,546.97 / $1,978.67
| Professional | | $1,199.33 | $1,546.97 | $1,978.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.23 / $1,586.10 / $2,477.90
| Professional | | $832.23 | $1,586.10 | $2,477.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.98 / $1,476.27 / $2,130.56
| Professional | | $828.98 | $1,476.27 | $2,130.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.98 / $1,494.51 / $1,817.85
| Professional | | $828.98 | $1,494.51 | $1,817.85 |