- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.71 / $578.59 / $714.37
| Professional | | $505.71 | $578.59 | $714.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.07 / $591.47 / $839.88
| Professional | | $474.07 | $591.47 | $839.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.19 / $387.82 / $550.53
| Professional | | $79.19 | $387.82 | $550.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.22 / $674.00 / $1,299.92
| Professional | | $546.22 | $674.00 | $1,299.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.82 / $668.75 / $1,132.80
| Professional | | $531.82 | $668.75 | $1,132.80 |