- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $724.44 / $1,513.56
| Professional | | $457.09 | $724.44 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,071.52
| Professional | | $501.19 | $776.25 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $891.25 / $1,621.81
| Professional | | $562.34 | $891.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,047.13 / $1,862.09
| Professional | | $616.60 | $1,047.13 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,995.26
| Professional | | $489.78 | $794.33 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $707.95 / $1,548.82
| Professional | | $446.68 | $707.95 | $1,548.82 |