- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.05 / $863.36 / $1,172.79
| Professional | | $662.05 | $863.36 | $1,172.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.46 / $578.91 / $972.56
| Professional | | $157.46 | $578.91 | $972.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.98 / $848.78 / $1,370.57
| Professional | | $654.98 | $848.78 | $1,370.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.30 / $863.36 / $1,357.59
| Professional | | $805.30 | $863.36 | $1,357.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.66 / $693.96 / $1,031.73
| Professional | | $65.66 | $693.96 | $1,031.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.14 / $1,148.88 / $1,512.88
| Professional | | $943.14 | $1,148.88 | $1,512.88 |