- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.41 / $551.39 / $551.39
| Professional | | $532.41 | $551.39 | $551.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.05 / $791.05 / $1,628.62
| Professional | | $791.05 | $791.05 | $1,628.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.08 / $776.50 / $1,009.53
| Professional | | $489.08 | $776.50 | $1,009.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.82 / $667.91 / $1,009.53
| Professional | | $465.82 | $667.91 | $1,009.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.96 / $634.07 / $1,843.30
| Professional | | $584.96 | $634.07 | $1,843.30 |