- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.69 / $442.29 / $616.96
| Professional | | $425.69 | $442.29 | $616.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.41 / $796.15 / $1,912.94
| Professional | | $675.41 | $796.15 | $1,912.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.88 / $711.43 / $1,191.66
| Professional | | $485.88 | $711.43 | $1,191.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.88 / $716.04 / $1,191.66
| Professional | | $485.88 | $716.04 | $1,191.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.89 / $748.47 / $2,175.85
| Professional | | $580.89 | $748.47 | $2,175.85 |