- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.63 / $545.16 / $724.81
| Professional | | $477.63 | $545.16 | $724.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.13 / $785.70 / $1,121.55
| Professional | | $607.13 | $785.70 | $1,121.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.21 / $871.67 / $1,252.32
| Professional | | $601.21 | $871.67 | $1,252.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.48 / $847.48 / $1,300.08
| Professional | | $732.48 | $847.48 | $1,300.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.63 / $549.28 / $724.81
| Professional | | $477.63 | $549.28 | $724.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.49 / $754.27 / $1,166.17
| Professional | | $496.49 | $754.27 | $1,166.17 |