- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $1,288.25
| Professional | | $416.87 | $575.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $758.58 / $1,122.02
| Professional | | $489.78 | $758.58 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $707.95 / $1,148.15
| Professional | | $549.54 | $707.95 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $741.31 / $1,380.38
| Professional | | $616.60 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,479.11
| Professional | | $467.74 | $660.69 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $630.96 / $1,096.48
| Professional | | $426.58 | $630.96 | $1,096.48 |