- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.70 / $750.39 / $1,224.50
| Professional | | $580.70 | $750.39 | $1,224.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.60 / $1,027.50 / $2,125.25
| Professional | | $633.60 | $1,027.50 | $2,125.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.37 / $1,099.31 / $1,256.27
| Professional | | $741.37 | $1,099.31 | $1,256.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.25 / $884.08 / $1,872.05
| Professional | | $563.25 | $884.08 | $1,872.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.49 / $1,046.43 / $2,427.91
| Professional | | $625.49 | $1,046.43 | $2,427.91 |