- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.05 / $877.12 / $953.02
| Professional | | $662.05 | $877.12 | $953.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.21 / $741.12 / $1,150.92
| Professional | | $536.21 | $741.12 | $1,150.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.21 / $860.44 / $1,199.66
| Professional | | $748.21 | $860.44 | $1,199.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.39 / $901.77 / $1,684.26
| Professional | | $669.39 | $901.77 | $1,684.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.57 / $980.89 / $1,898.91
| Professional | | $741.57 | $980.89 | $1,898.91 |