- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.30 / $757.23 / $905.86
| Professional | | $601.30 | $757.23 | $905.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.37 / $977.54 / $1,392.31
| Professional | | $755.37 | $977.54 | $1,392.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.26 / $1,087.04 / $1,555.79
| Professional | | $744.26 | $1,087.04 | $1,555.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.31 / $1,052.07 / $1,613.93
| Professional | | $909.31 | $1,052.07 | $1,613.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.30 / $826.87 / $905.86
| Professional | | $601.30 | $826.87 | $905.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.86 / $972.78 / $1,545.18
| Professional | | $686.86 | $972.78 | $1,545.18 |