- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.83 / $531.64 / $551.99
| Professional | | $393.83 | $531.64 | $551.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.08 / $547.04 / $1,621.21
| Professional | | $464.08 | $547.04 | $1,621.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.90 / $793.34 / $1,027.46
| Professional | | $477.90 | $793.34 | $1,027.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.91 / $677.70 / $1,027.46
| Professional | | $475.91 | $677.70 | $1,027.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.41 / $645.33 / $1,876.02
| Professional | | $614.41 | $645.33 | $1,876.02 |