- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.05 / $581.28 / $853.73
| Professional | | $84.05 | $581.28 | $853.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.01 / $665.35 / $1,023.62
| Professional | | $82.01 | $665.35 | $1,023.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.25 / $638.60 / $1,058.34
| Professional | | $69.25 | $638.60 | $1,058.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.59 / $621.38 / $1,665.50
| Professional | | $63.59 | $621.38 | $1,665.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.65 / $77.59 / $981.12
| Professional | | $70.65 | $77.59 | $981.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.07 / $885.87 / $1,286.46
| Professional | | $678.07 | $885.87 | $1,286.46 |