- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.48 / $703.34 / $856.10
| Professional | | $618.48 | $703.34 | $856.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.44 / $924.57 / $1,320.37
| Professional | | $714.44 | $924.57 | $1,320.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.52 / $1,027.32 / $1,472.49
| Professional | | $706.52 | $1,027.32 | $1,472.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.32 / $997.70 / $1,530.53
| Professional | | $862.32 | $997.70 | $1,530.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.48 / $856.10 / $1,328.57
| Professional | | $618.48 | $856.10 | $1,328.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.64 / $937.90 / $1,212.81
| Professional | | $650.64 | $937.90 | $1,212.81 |