- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.26 / $962.97 / $1,268.99
| Professional | | $912.26 | $962.97 | $1,268.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.00 / $959.38 / $1,323.94
| Professional | | $768.00 | $959.38 | $1,323.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.68 / $1,098.82 / $1,373.52
| Professional | | $915.68 | $1,098.82 | $1,373.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.88 / $1,246.80 / $2,106.07
| Professional | | $932.88 | $1,246.80 | $2,106.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.26 / $1,170.21 / $2,046.51
| Professional | | $900.26 | $1,170.21 | $2,046.51 |