- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.21 / $807.39 / $959.92
| Professional | | $638.21 | $807.39 | $959.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.39 / $1,039.68 / $1,483.83
| Professional | | $803.39 | $1,039.68 | $1,483.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.78 / $1,152.83 / $1,656.34
| Professional | | $794.78 | $1,152.83 | $1,656.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.08 / $1,121.23 / $1,720.02
| Professional | | $969.08 | $1,121.23 | $1,720.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.21 / $872.16 / $959.92
| Professional | | $638.21 | $872.16 | $959.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.36 / $1,029.09 / $1,542.97
| Professional | | $640.36 | $1,029.09 | $1,542.97 |