- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.16 / $623.54 / $741.20
| Professional | | $492.16 | $623.54 | $741.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.19 / $802.60 / $1,144.27
| Professional | | $620.19 | $802.60 | $1,144.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.12 / $889.44 / $1,278.83
| Professional | | $613.12 | $889.44 | $1,278.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.32 / $864.65 / $1,326.42
| Professional | | $747.32 | $864.65 | $1,326.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.16 / $673.40 / $741.20
| Professional | | $492.16 | $673.40 | $741.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.08 / $792.14 / $1,024.31
| Professional | | $514.08 | $792.14 | $1,024.31 |