- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $794.33 / $1,905.46
| Professional | | $645.65 | $794.33 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,071.52 / $1,513.56
| Professional | | $660.69 | $1,071.52 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $1,584.89
| Professional | | $758.58 | $1,023.29 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $977.24 / $1,862.09
| Professional | | $812.83 | $977.24 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $954.99 / $2,187.76
| Professional | | $691.83 | $954.99 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $1,479.11
| Professional | | $602.56 | $891.25 | $1,479.11 |