- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.98 / $688.04 / $770.60
| Professional | | $556.98 | $688.04 | $770.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.54 / $844.17 / $1,617.86
| Professional | | $661.54 | $844.17 | $1,617.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.64 / $345.77 / $488.85
| Professional | | $80.64 | $345.77 | $488.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.91 / $884.45 / $1,233.91
| Professional | | $587.91 | $884.45 | $1,233.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.52 / $723.20 / $1,093.23
| Professional | | $555.52 | $723.20 | $1,093.23 |