- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.75 / $826.05 / $1,120.28
| Professional | | $646.75 | $826.05 | $1,120.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.47 / $646.70 / $1,031.79
| Professional | | $462.47 | $646.70 | $1,031.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.14 / $812.43 / $1,272.51
| Professional | | $620.14 | $812.43 | $1,272.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.34 / $919.05 / $1,534.43
| Professional | | $663.34 | $919.05 | $1,534.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.81 / $969.85 / $1,703.28
| Professional | | $784.81 | $969.85 | $1,703.28 |