- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.82 / $654.66 / $969.48
| Professional | | $500.82 | $654.66 | $969.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.91 / $922.87 / $2,185.17
| Professional | | $782.91 | $922.87 | $2,185.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.30 / $933.80 / $1,183.56
| Professional | | $550.30 | $933.80 | $1,183.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.30 / $870.06 / $1,183.56
| Professional | | $550.30 | $870.06 | $1,183.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.49 / $826.89 / $2,438.40
| Professional | | $667.49 | $826.89 | $2,438.40 |