- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.27 / $931.86 / $1,239.90
| Professional | | $889.27 | $931.86 | $1,239.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.44 / $1,185.20 / $1,635.57
| Professional | | $912.44 | $1,185.20 | $1,635.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.75 / $1,076.09 / $1,345.13
| Professional | | $896.75 | $1,076.09 | $1,345.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.52 / $1,310.23 / $2,385.56
| Professional | | $953.52 | $1,310.23 | $2,385.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.46 / $1,240.48 / $2,263.88
| Professional | | $950.46 | $1,240.48 | $2,263.88 |