- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $537.03 / $1,230.27
| Professional | | $426.58 | $537.03 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $1,047.13
| Professional | | $457.09 | $707.95 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $1,096.48
| Professional | | $512.86 | $660.69 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $691.83 / $1,318.26
| Professional | | $575.44 | $691.83 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $1,412.54
| Professional | | $426.58 | $616.60 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $1,023.29
| Professional | | $407.38 | $575.44 | $1,023.29 |