- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.58 / $787.61 / $943.02
| Professional | | $625.58 | $787.61 | $943.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.09 / $1,017.30 / $1,449.75
| Professional | | $786.09 | $1,017.30 | $1,449.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.84 / $1,131.61 / $1,618.57
| Professional | | $774.84 | $1,131.61 | $1,618.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.82 / $1,095.47 / $1,680.51
| Professional | | $946.82 | $1,095.47 | $1,680.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.58 / $865.09 / $943.02
| Professional | | $625.58 | $865.09 | $943.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.69 / $1,036.14 / $1,504.07
| Professional | | $716.69 | $1,036.14 | $1,504.07 |