- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.99 / $1,084.20 / $1,747.39
| Professional | | $939.99 | $1,084.20 | $1,747.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.33 / $1,597.68 / $3,458.35
| Professional | | $1,022.33 | $1,597.68 | $3,458.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.52 / $1,545.36 / $1,574.08
| Professional | | $902.52 | $1,545.36 | $1,574.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.16 / $1,297.30 / $2,768.10
| Professional | | $882.16 | $1,297.30 | $2,768.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.54 / $1,411.24 / $3,192.04
| Professional | | $843.54 | $1,411.24 | $3,192.04 |