- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.63 / $424.51 / $1,056.33
| Professional | | $301.63 | $424.51 | $1,056.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.63 / $845.55 / $1,301.76
| Professional | | $543.63 | $845.55 | $1,301.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.73 / $854.70 / $1,121.84
| Professional | | $584.73 | $854.70 | $1,121.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.76 / $765.35 / $1,156.46
| Professional | | $581.76 | $765.35 | $1,156.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.55 / $886.82 / $1,203.59
| Professional | | $643.55 | $886.82 | $1,203.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.84 / $925.14 / $1,341.66
| Professional | | $659.84 | $925.14 | $1,341.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.66 / $922.16 / $1,566.79
| Professional | | $529.66 | $922.16 | $1,566.79 |