- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.97 / $600.66 / $658.03
| Professional | | $434.97 | $600.66 | $658.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.70 / $843.65 / $2,018.05
| Professional | | $715.70 | $843.65 | $2,018.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.41 / $852.50 / $1,163.95
| Professional | | $584.41 | $852.50 | $1,163.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.04 / $766.34 / $1,163.95
| Professional | | $530.04 | $766.34 | $1,163.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.96 / $731.05 / $2,125.21
| Professional | | $621.96 | $731.05 | $2,125.21 |