- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.44 / $715.35 / $1,128.55
| Professional | | $560.44 | $715.35 | $1,128.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.06 / $904.57 / $1,377.08
| Professional | | $753.06 | $904.57 | $1,377.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.56 / $1,143.46 / $1,678.22
| Professional | | $661.56 | $1,143.46 | $1,678.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.57 / $1,068.54 / $1,772.43
| Professional | | $870.57 | $1,068.54 | $1,772.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.44 / $792.50 / $1,128.55
| Professional | | $560.44 | $792.50 | $1,128.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.14 / $1,179.17 / $1,709.87
| Professional | | $813.14 | $1,179.17 | $1,709.87 |