- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,548.82
| Professional | | $562.34 | $794.33 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $977.24 / $1,288.25
| Professional | | $512.86 | $977.24 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $870.96 / $1,513.56
| Professional | | $660.69 | $870.96 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $912.01 / $1,380.38
| Professional | | $758.58 | $912.01 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $954.99 / $1,862.09
| Professional | | $562.34 | $954.99 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $1,513.56
| Professional | | $616.60 | $891.25 | $1,513.56 |