- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.54 / $600.54 / $620.35
| Professional | | $600.54 | $600.54 | $620.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.82 / $857.92 / $1,891.16
| Professional | | $727.82 | $857.92 | $1,891.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.40 / $843.94 / $1,162.95
| Professional | | $572.40 | $843.94 | $1,162.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.94 / $770.87 / $1,162.95
| Professional | | $536.94 | $770.87 | $1,162.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.79 / $730.44 / $1,231.38
| Professional | | $597.79 | $730.44 | $1,231.38 |