- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.77 / $883.40 / $1,628.42
| Professional | | $655.77 | $883.40 | $1,628.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.25 / $1,069.38 / $1,622.98
| Professional | | $887.25 | $1,069.38 | $1,622.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.45 / $1,325.61 / $1,977.82
| Professional | | $775.45 | $1,325.61 | $1,977.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.96 / $1,256.05 / $2,093.73
| Professional | | $1,018.96 | $1,256.05 | $2,093.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.76 / $931.72 / $1,673.07
| Professional | | $655.76 | $931.72 | $1,673.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.91 / $1,398.28 / $2,019.54
| Professional | | $1,008.91 | $1,398.28 | $2,019.54 |