- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $616.60 / $1,258.93
| Professional | | $446.68 | $616.60 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $794.33 / $1,174.90
| Professional | | $524.81 | $794.33 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $741.31 / $1,230.27
| Professional | | $524.81 | $741.31 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $776.25 / $1,445.44
| Professional | | $645.65 | $776.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $691.83 / $1,584.89
| Professional | | $489.78 | $691.83 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $660.69 / $1,148.15
| Professional | | $446.68 | $660.69 | $1,148.15 |