- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.24 / $938.67 / $1,555.55
| Professional | | $772.24 | $938.67 | $1,555.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.90 / $1,379.25 / $2,993.61
| Professional | | $819.90 | $1,379.25 | $2,993.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.56 / $1,482.70 / $1,560.35
| Professional | | $878.56 | $1,482.70 | $1,560.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.30 / $1,171.33 / $2,381.76
| Professional | | $709.30 | $1,171.33 | $2,381.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.64 / $1,264.04 / $3,440.64
| Professional | | $812.64 | $1,264.04 | $3,440.64 |