- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.13 / $734.74 / $877.00
| Professional | | $582.13 | $734.74 | $877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.44 / $947.87 / $1,350.66
| Professional | | $732.44 | $947.87 | $1,350.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.69 / $1,052.40 / $1,508.73
| Professional | | $722.69 | $1,052.40 | $1,508.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.11 / $1,020.60 / $1,565.66
| Professional | | $882.11 | $1,020.60 | $1,565.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.13 / $797.93 / $877.00
| Professional | | $582.13 | $797.93 | $877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.52 / $963.00 / $1,402.87
| Professional | | $666.52 | $963.00 | $1,402.87 |