- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.62 / $669.62 / $676.01
| Professional | | $669.62 | $669.62 | $676.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.73 / $982.78 / $2,059.69
| Professional | | $833.73 | $982.78 | $2,059.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.16 / $945.38 / $1,273.34
| Professional | | $626.16 | $945.38 | $1,273.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.62 / $844.50 / $1,273.34
| Professional | | $588.62 | $844.50 | $1,273.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.12 / $799.76 / $2,324.96
| Professional | | $678.12 | $799.76 | $2,324.96 |