- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.76 / $904.31 / $1,096.11
| Professional | | $708.76 | $904.31 | $1,096.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.57 / $1,144.74 / $1,614.48
| Professional | | $884.57 | $1,144.74 | $1,614.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.42 / $1,307.59 / $1,850.86
| Professional | | $857.42 | $1,307.59 | $1,850.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.41 / $1,219.95 / $1,871.47
| Professional | | $1,054.41 | $1,219.95 | $1,871.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.76 / $983.82 / $1,096.11
| Professional | | $708.76 | $983.82 | $1,096.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.37 / $1,178.52 / $2,137.88
| Professional | | $745.37 | $1,178.52 | $2,137.88 |