- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.58 / $561.77 / $616.96
| Professional | | $403.58 | $561.77 | $616.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.37 / $859.76 / $1,897.95
| Professional | | $729.37 | $859.76 | $1,897.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.13 / $824.94 / $1,153.58
| Professional | | $532.13 | $824.94 | $1,153.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.27 / $763.49 / $1,153.58
| Professional | | $649.27 | $763.49 | $1,153.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.25 / $724.56 / $2,106.34
| Professional | | $600.25 | $724.56 | $2,106.34 |