- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $602.56 / $1,148.15
| Professional | | $457.09 | $602.56 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $794.33 / $1,174.90
| Professional | | $537.03 | $794.33 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,202.26
| Professional | | $478.63 | $691.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $851.14 / $1,621.81
| Professional | | $645.65 | $851.14 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $676.08 / $1,737.80
| Professional | | $457.09 | $676.08 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $1,258.93
| Professional | | $436.52 | $630.96 | $1,258.93 |