- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $1,258.93
| Professional | | $436.52 | $602.56 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $645.65 / $1,047.13
| Professional | | $416.87 | $645.65 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $1,122.02
| Professional | | $537.03 | $724.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $1,479.11
| Professional | | $512.86 | $724.44 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,698.24
| Professional | | $467.74 | $676.08 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,148.15
| Professional | | $457.09 | $691.83 | $1,148.15 |