- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $537.03 / $1,096.48
| Professional | | $426.58 | $537.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $1,047.13
| Professional | | $457.09 | $707.95 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $1,071.52
| Professional | | $501.19 | $660.69 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $676.08 / $1,288.25
| Professional | | $562.34 | $676.08 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $1,380.38
| Professional | | $436.52 | $660.69 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $1,000.00
| Professional | | $407.38 | $602.56 | $1,000.00 |