- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $691.83 / $1,548.82
| Professional | | $501.19 | $691.83 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,318.26
| Professional | | $575.44 | $891.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $851.14 / $1,380.38
| Professional | | $660.69 | $851.14 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $851.14 / $1,621.81
| Professional | | $707.95 | $851.14 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $1,737.80
| Professional | | $575.44 | $831.76 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $758.58 / $1,288.25
| Professional | | $512.86 | $758.58 | $1,288.25 |