- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.01 / $509.43 / $1,061.11
| Professional | | $420.01 | $509.43 | $1,061.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.36 / $690.44 / $1,036.05
| Professional | | $565.36 | $690.44 | $1,036.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.60 / $892.70 / $1,263.91
| Professional | | $492.60 | $892.70 | $1,263.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.11 / $808.99 / $1,335.92
| Professional | | $659.11 | $808.99 | $1,335.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.01 / $553.73 / $1,061.11
| Professional | | $420.01 | $553.73 | $1,061.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.35 / $880.43 / $1,286.38
| Professional | | $612.35 | $880.43 | $1,286.38 |