- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.26 / $740.82 / $776.14
| Professional | | $535.26 | $740.82 | $776.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.60 / $956.70 / $2,277.04
| Professional | | $811.60 | $956.70 | $2,277.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.63 / $1,047.93 / $1,405.92
| Professional | | $678.63 | $1,047.93 | $1,405.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.92 / $930.12 / $1,405.92
| Professional | | $648.92 | $930.12 | $1,405.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.76 / $883.04 / $2,567.05
| Professional | | $723.76 | $883.04 | $2,567.05 |