- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.21 / $484.34 / $893.67
| Professional | | $330.21 | $484.34 | $893.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.72 / $847.40 / $3,059.12
| Professional | | $416.72 | $847.40 | $3,059.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.04 / $802.35 / $1,648.25
| Professional | | $483.04 | $802.35 | $1,648.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.66 / $739.16 / $1,020.32
| Professional | | $584.66 | $739.16 | $1,020.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.60 / $1,072.80 / $1,433.32
| Professional | | $520.60 | $1,072.80 | $1,433.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.87 / $1,050.26 / $3,794.00
| Professional | | $536.87 | $1,050.26 | $3,794.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.80 / $767.46 / $1,461.67
| Professional | | $460.80 | $767.46 | $1,461.67 |