- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.50 / $758.50 / $1,343.30
| Professional | | $591.50 | $758.50 | $1,343.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.58 / $712.32 / $783.55
| Professional | | $582.58 | $712.32 | $783.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.35 / $913.63 / $1,820.78
| Professional | | $599.35 | $913.63 | $1,820.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.67 / $1,053.50 / $1,404.61
| Professional | | $816.67 | $1,053.50 | $1,404.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.90 / $938.77 / $1,720.82
| Professional | | $648.90 | $938.77 | $1,720.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.14 / $939.17 / $1,163.66
| Professional | | $604.14 | $939.17 | $1,163.66 |