- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.25 / $525.61 / $713.69
| Professional | | $376.25 | $525.61 | $713.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.36 / $760.74 / $2,124.30
| Professional | | $645.36 | $760.74 | $2,124.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.88 / $783.56 / $1,349.12
| Professional | | $565.88 | $783.56 | $1,349.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.79 / $825.90 / $1,349.12
| Professional | | $591.79 | $825.90 | $1,349.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.29 / $833.56 / $2,463.35
| Professional | | $640.29 | $833.56 | $2,463.35 |