- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.88 / $648.55 / $688.22
| Professional | | $628.88 | $648.55 | $688.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.53 / $968.40 / $2,114.15
| Professional | | $821.53 | $968.40 | $2,114.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.47 / $922.84 / $1,288.27
| Professional | | $598.47 | $922.84 | $1,288.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.43 / $852.88 / $1,288.27
| Professional | | $718.43 | $852.88 | $1,288.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.29 / $809.14 / $2,352.23
| Professional | | $673.29 | $809.14 | $2,352.23 |