- 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
- $597.97 / $982.96 / $1,420.75
| Professional | | $597.97 | $982.96 | $1,420.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.98 / $1,341.45 / $2,312.88
| Professional | | $822.98 | $1,341.45 | $2,312.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.30 / $1,286.83 / $2,403.11
| Professional | | $737.30 | $1,286.83 | $2,403.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.50 / $1,158.94 / $2,339.42
| Professional | | $876.50 | $1,158.94 | $2,339.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.80 / $643.08 / $771.70
| Professional | | $482.80 | $643.08 | $771.70 |