- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.77 / $678.42 / $680.65
| Professional | | $487.77 | $678.42 | $680.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.50 / $873.50 / $2,064.80
| Professional | | $873.50 | $873.50 | $2,064.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.41 / $978.67 / $1,278.27
| Professional | | $628.41 | $978.67 | $1,278.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.14 / $847.87 / $1,278.27
| Professional | | $591.14 | $847.87 | $1,278.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.65 / $802.86 / $2,333.96
| Professional | | $711.65 | $802.86 | $2,333.96 |