- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.60 / $774.91 / $927.82
| Professional | | $677.60 | $774.91 | $927.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.38 / $1,000.84 / $1,425.76
| Professional | | $773.38 | $1,000.84 | $1,425.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.87 / $1,113.39 / $1,592.56
| Professional | | $761.87 | $1,113.39 | $1,592.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.16 / $1,077.34 / $1,652.72
| Professional | | $931.16 | $1,077.34 | $1,652.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.71 / $844.83 / $927.82
| Professional | | $615.71 | $844.83 | $927.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.15 / $1,016.13 / $1,480.16
| Professional | | $705.15 | $1,016.13 | $1,480.16 |