- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.40 / $984.69 / $984.69
| Professional | | $720.40 | $984.69 | $984.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.04 / $879.90 / $1,208.23
| Professional | | $645.04 | $879.90 | $1,208.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.45 / $926.88 / $1,219.89
| Professional | | $655.45 | $926.88 | $1,219.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.81 / $1,404.07 / $6,882.96
| Professional | | $784.81 | $1,404.07 | $6,882.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.44 / $945.55 / $1,516.12
| Professional | | $756.44 | $945.55 | $1,516.12 |