- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $616.60 / $1,412.54
| Professional | | $489.78 | $616.60 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $812.83 / $1,174.90
| Professional | | $524.81 | $812.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,230.27
| Professional | | $602.56 | $758.58 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $776.25 / $1,479.11
| Professional | | $645.65 | $776.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $758.58 / $1,584.89
| Professional | | $512.86 | $758.58 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $691.83 / $1,148.15
| Professional | | $467.74 | $691.83 | $1,148.15 |