- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $1,230.27
| Professional | | $512.86 | $645.65 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $758.58 / $1,047.13
| Professional | | $478.63 | $758.58 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $1,230.27
| Professional | | $616.60 | $724.44 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $1,096.48
| Professional | | $602.56 | $741.31 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $1,548.82
| Professional | | $512.86 | $645.65 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $1,202.26
| Professional | | $575.44 | $831.76 | $1,202.26 |