- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.31 / $399.75 / $570.97
| Professional | | $386.31 | $399.75 | $570.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.28 / $712.31 / $1,740.70
| Professional | | $604.28 | $712.31 | $1,740.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.55 / $637.03 / $1,106.42
| Professional | | $433.55 | $637.03 | $1,106.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.56 / $664.57 / $1,106.42
| Professional | | $452.56 | $664.57 | $1,106.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.24 / $694.92 / $2,020.18
| Professional | | $527.24 | $694.92 | $2,020.18 |