- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.25 / $650.49 / $659.62
| Professional | | $467.25 | $650.49 | $659.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.32 / $829.05 / $2,021.90
| Professional | | $703.32 | $829.05 | $2,021.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.57 / $904.18 / $1,239.60
| Professional | | $608.57 | $904.18 | $1,239.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.20 / $821.04 / $1,239.60
| Professional | | $571.20 | $821.04 | $1,239.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.83 / $765.90 / $2,263.39
| Professional | | $630.83 | $765.90 | $2,263.39 |