- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.84 / $592.84 / $1,024.23
| Professional | | $592.84 | $592.84 | $1,024.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.72 / $787.52 / $1,258.67
| Professional | | $687.72 | $787.52 | $1,258.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.02 / $893.77 / $1,280.49
| Professional | | $691.02 | $893.77 | $1,280.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.28 / $859.40 / $1,318.36
| Professional | | $667.28 | $859.40 | $1,318.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.84 / $592.84 / $1,024.23
| Professional | | $592.84 | $592.84 | $1,024.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.22 / $867.78 / $1,191.50
| Professional | | $597.22 | $867.78 | $1,191.50 |