- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.67 / $552.67 / $627.28
| Professional | | $552.67 | $552.67 | $627.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.79 / $756.17 / $1,316.25
| Professional | | $591.79 | $756.17 | $1,316.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.92 / $1,085.58 / $1,756.32
| Professional | | $562.92 | $1,085.58 | $1,756.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.80 / $1,223.46 / $1,223.46
| Professional | | $531.80 | $1,223.46 | $1,223.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.10 / $891.25 / $1,898.80
| Professional | | $527.10 | $891.25 | $1,898.80 |