- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $630.96 / $1,000.00
| Professional | | $524.81 | $630.96 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $660.69 / $691.83
| Professional | | $575.44 | $660.69 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $1,288.25
| Professional | | $549.54 | $812.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $645.65 / $912.01
| Professional | | $537.03 | $645.65 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $1,348.96
| Professional | | $489.78 | $741.31 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $707.95 / $1,000.00
| Professional | | $575.44 | $707.95 | $1,000.00 |