- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.16 / $607.08 / $1,095.96
| Professional | | $531.16 | $607.08 | $1,095.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.81 / $830.20 / $1,291.42
| Professional | | $661.81 | $830.20 | $1,291.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.98 / $916.89 / $1,451.67
| Professional | | $521.98 | $916.89 | $1,451.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.36 / $1,010.43 / $1,496.88
| Professional | | $843.36 | $1,010.43 | $1,496.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.16 / $655.91 / $1,095.96
| Professional | | $531.16 | $655.91 | $1,095.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.14 / $935.80 / $1,353.38
| Professional | | $643.14 | $935.80 | $1,353.38 |