- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $616.60 / $1,023.29
| Professional | | $398.11 | $616.60 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $741.31
| Professional | | $354.81 | $562.34 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $1,230.27
| Professional | | $602.56 | $851.14 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $741.31 / $1,174.90
| Professional | | $436.52 | $741.31 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $831.76 / $1,380.38
| Professional | | $467.74 | $831.76 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $676.08 / $977.24
| Professional | | $436.52 | $676.08 | $977.24 |