- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.04 / $532.57 / $724.54
| Professional | | $512.04 | $532.57 | $724.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.43 / $772.60 / $2,190.26
| Professional | | $655.43 | $772.60 | $2,190.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.66 / $801.81 / $1,398.90
| Professional | | $573.66 | $801.81 | $1,398.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.07 / $838.54 / $1,398.90
| Professional | | $598.07 | $838.54 | $1,398.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.60 / $820.38 / $2,554.23
| Professional | | $635.60 | $820.38 | $2,554.23 |