- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.61 / $572.52 / $572.97
| Professional | | $485.61 | $572.52 | $572.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.66 / $914.33 / $1,765.11
| Professional | | $775.66 | $914.33 | $1,765.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.25 / $810.83 / $1,079.20
| Professional | | $524.25 | $810.83 | $1,079.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.02 / $713.24 / $1,079.20
| Professional | | $496.02 | $713.24 | $1,079.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.57 / $677.82 / $1,970.48
| Professional | | $591.57 | $677.82 | $1,970.48 |