- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $630.96 / $1,202.26
| Professional | | $537.03 | $630.96 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $812.83 / $1,122.02
| Professional | | $457.09 | $812.83 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $724.44 / $1,174.90
| Professional | | $602.56 | $724.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $1,071.52
| Professional | | $602.56 | $741.31 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $758.58 / $1,698.24
| Professional | | $537.03 | $758.58 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $758.58 / $1,174.90
| Professional | | $537.03 | $758.58 | $1,174.90 |