- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.14 / $713.05 / $850.17
| Professional | | $593.14 | $713.05 | $850.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.48 / $730.33 / $803.36
| Professional | | $510.48 | $730.33 | $803.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.57 / $885.72 / $1,745.49
| Professional | | $597.57 | $885.72 | $1,745.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.69 / $1,030.45 / $1,402.92
| Professional | | $795.69 | $1,030.45 | $1,402.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.94 / $835.31 / $1,518.33
| Professional | | $581.94 | $835.31 | $1,518.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.74 / $918.62 / $1,136.70
| Professional | | $683.74 | $918.62 | $1,136.70 |