- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.25 / $414.26 / $1,004.81
| Professional | | $369.25 | $414.26 | $1,004.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.89 / $690.49 / $1,039.61
| Professional | | $527.89 | $690.49 | $1,039.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.73 / $805.98 / $1,189.64
| Professional | | $629.73 | $805.98 | $1,189.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.71 / $778.33 / $1,460.32
| Professional | | $672.71 | $778.33 | $1,460.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.25 / $445.36 / $1,004.81
| Professional | | $369.25 | $445.36 | $1,004.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.12 / $590.80 / $1,182.25
| Professional | | $403.12 | $590.80 | $1,182.25 |