- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.70 / $776.67 / $1,025.74
| Professional | | $580.70 | $776.67 | $1,025.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.16 / $831.06 / $1,157.90
| Professional | | $710.16 | $831.06 | $1,157.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.82 / $1,170.25 / $1,712.03
| Professional | | $755.82 | $1,170.25 | $1,712.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.85 / $975.68 / $1,731.73
| Professional | | $751.85 | $975.68 | $1,731.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.21 / $776.67 / $1,025.74
| Professional | | $666.21 | $776.67 | $1,025.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.51 / $1,073.94 / $1,566.36
| Professional | | $697.51 | $1,073.94 | $1,566.36 |