- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.45 / $756.21 / $1,458.65
| Professional | | $675.45 | $756.21 | $1,458.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.60 / $754.60 / $1,116.32
| Professional | | $754.60 | $754.60 | $1,116.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.48 / $817.61 / $1,438.44
| Professional | | $583.48 | $817.61 | $1,438.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.60 / $893.65 / $1,460.94
| Professional | | $638.60 | $893.65 | $1,460.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.82 / $759.57 / $1,162.14
| Professional | | $6.82 | $759.57 | $1,162.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.82 / $744.21 / $1,139.35
| Professional | | $6.82 | $744.21 | $1,139.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.51 / $755.98 / $1,314.21
| Professional | | $318.51 | $755.98 | $1,314.21 |