- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.35 / $587.97 / $1,008.71
| Professional | | $554.35 | $587.97 | $1,008.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.51 / $782.86 / $1,237.73
| Professional | | $682.51 | $782.86 | $1,237.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.14 / $881.58 / $1,263.01
| Professional | | $715.14 | $881.58 | $1,263.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.17 / $845.10 / $1,296.42
| Professional | | $656.17 | $845.10 | $1,296.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.35 / $587.97 / $1,008.71
| Professional | | $554.35 | $587.97 | $1,008.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.77 / $869.44 / $1,170.92
| Professional | | $633.77 | $869.44 | $1,170.92 |