- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $707.95 / $1,380.38
| Professional | | $549.54 | $707.95 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $831.76 / $1,174.90
| Professional | | $524.81 | $831.76 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $1,380.38
| Professional | | $575.44 | $794.33 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $851.14 / $1,230.27
| Professional | | $691.83 | $851.14 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $645.65 / $1,513.56
| Professional | | $549.54 | $645.65 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $1,348.96
| Professional | | $562.34 | $812.83 | $1,348.96 |