- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.24 / $750.43 / $911.30
| Professional | | $695.24 | $750.43 | $911.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.92 / $974.03 / $974.03
| Professional | | $827.92 | $974.03 | $974.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.82 / $1,068.24 / $1,260.52
| Professional | | $779.82 | $1,068.24 | $1,260.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.12 / $1,030.88 / $1,992.04
| Professional | | $760.12 | $1,030.88 | $1,992.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.21 / $899.73 / $1,251.55
| Professional | | $703.21 | $899.73 | $1,251.55 |