- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.68 / $759.64 / $759.64
| Professional | | $752.68 | $759.64 | $759.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.42 / $1,145.08 / $2,283.75
| Professional | | $971.42 | $1,145.08 | $2,283.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.22 / $1,087.42 / $1,420.51
| Professional | | $697.22 | $1,087.42 | $1,420.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.78 / $942.93 / $1,420.51
| Professional | | $657.78 | $942.93 | $1,420.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.88 / $892.19 / $1,512.38
| Professional | | $734.88 | $892.19 | $1,512.38 |