- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.16 / $666.50 / $1,131.43
| Professional | | $532.16 | $666.50 | $1,131.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.97 / $538.97 / $538.97
| Professional | | $538.97 | $538.97 | $538.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.52 / $978.63 / $1,286.67
| Professional | | $566.52 | $978.63 | $1,286.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.35 / $845.08 / $4,283.07
| Professional | | $696.35 | $845.08 | $4,283.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.71 / $800.26 / $1,351.78
| Professional | | $684.71 | $800.26 | $1,351.78 |