- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.59 / $959.86 / $1,164.94
| Professional | | $761.59 | $959.86 | $1,164.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.82 / $1,235.65 / $1,752.08
| Professional | | $954.82 | $1,235.65 | $1,752.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.46 / $1,397.93 / $1,971.87
| Professional | | $934.46 | $1,397.93 | $1,971.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.27 / $1,323.92 / $2,030.96
| Professional | | $1,144.27 | $1,323.92 | $2,030.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.20 / $1,030.25 / $1,164.94
| Professional | | $831.20 | $1,030.25 | $1,164.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.10 / $1,222.88 / $1,821.37
| Professional | | $797.10 | $1,222.88 | $1,821.37 |