- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.64 / $712.06 / $862.89
| Professional | | $584.64 | $712.06 | $862.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,756.73 / $1,756.73 / $1,756.73
| Professional | | $1,756.73 | $1,756.73 | $1,756.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.46 / $1,073.78 / $1,073.78
| Professional | | $993.46 | $1,073.78 | $1,073.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.84 / $873.48 / $1,256.02
| Professional | | $700.84 | $873.48 | $1,256.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.68 / $787.31 / $1,075.95
| Professional | | $673.68 | $787.31 | $1,075.95 |