- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $724.44 / $1,698.24
| Professional | | $549.54 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $977.24 / $1,380.38
| Professional | | $645.65 | $977.24 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $1,905.46
| Professional | | $741.31 | $1,071.52 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,023.29 / $1,584.89
| Professional | | $691.83 | $1,023.29 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,096.48 / $2,951.21
| Professional | | $549.54 | $1,096.48 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,071.52 / $1,737.80
| Professional | | $691.83 | $1,071.52 | $1,737.80 |