- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.61 / $670.48 / $855.03
| Professional | | $645.61 | $670.48 | $855.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.50 / $776.49 / $1,037.61
| Professional | | $577.50 | $776.49 | $1,037.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.76 / $863.40 / $1,121.26
| Professional | | $620.76 | $863.40 | $1,121.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.05 / $877.22 / $10,000.00
| Professional | | $688.05 | $877.22 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.18 / $834.30 / $1,198.25
| Professional | | $663.18 | $834.30 | $1,198.25 |