- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.26 / $817.48 / $1,067.06
| Professional | | $649.26 | $817.48 | $1,067.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.16 / $911.76 / $1,777.15
| Professional | | $604.16 | $911.76 | $1,777.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.83 / $1,079.57 / $2,256.69
| Professional | | $781.83 | $1,079.57 | $2,256.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.43 / $937.59 / $1,184.75
| Professional | | $722.43 | $937.59 | $1,184.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.06 / $662.92 / $1,206.75
| Professional | | $425.06 | $662.92 | $1,206.75 |