- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.54 / $645.29 / $1,131.86
| Professional | | $580.54 | $645.29 | $1,131.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.42 / $850.63 / $1,315.95
| Professional | | $674.42 | $850.63 | $1,315.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.48 / $1,030.76 / $1,494.78
| Professional | | $716.48 | $1,030.76 | $1,494.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.44 / $994.37 / $1,525.42
| Professional | | $859.44 | $994.37 | $1,525.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.51 / $645.29 / $808.23
| Professional | | $532.51 | $645.29 | $808.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.88 / $836.58 / $1,404.25
| Professional | | $582.88 | $836.58 | $1,404.25 |