- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.36 / $440.84 / $650.97
| Professional | | $420.36 | $440.84 | $650.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.55 / $930.71 / $1,929.73
| Professional | | $789.55 | $930.71 | $1,929.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.57 / $690.17 / $1,229.79
| Professional | | $459.57 | $690.17 | $1,229.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.49 / $752.68 / $1,229.79
| Professional | | $500.49 | $752.68 | $1,229.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.08 / $772.41 / $1,329.86
| Professional | | $658.08 | $772.41 | $1,329.86 |