- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.19 / $712.21 / $832.67
| Professional | | $561.19 | $712.21 | $832.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.37 / $915.43 / $1,307.10
| Professional | | $707.37 | $915.43 | $1,307.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.14 / $1,016.23 / $1,459.44
| Professional | | $701.14 | $1,016.23 | $1,459.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.67 / $987.70 / $1,515.18
| Professional | | $853.67 | $987.70 | $1,515.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.19 / $766.78 / $832.67
| Professional | | $561.19 | $766.78 | $832.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.83 / $903.67 / $1,168.54
| Professional | | $632.83 | $903.67 | $1,168.54 |