- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.68 / $570.94 / $804.78
| Professional | | $441.68 | $570.94 | $804.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.27 / $684.49 / $985.24
| Professional | | $581.27 | $684.49 | $985.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.50 / $965.74 / $1,466.66
| Professional | | $613.50 | $965.74 | $1,466.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.72 / $924.56 / $1,641.00
| Professional | | $740.72 | $924.56 | $1,641.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.68 / $552.15 / $804.78
| Professional | | $441.68 | $552.15 | $804.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.26 / $775.96 / $1,372.77
| Professional | | $554.26 | $775.96 | $1,372.77 |