- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.35 / $941.73 / $1,070.96
| Professional | | $667.35 | $941.73 | $1,070.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.63 / $1,068.46 / $1,543.17
| Professional | | $825.63 | $1,068.46 | $1,543.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.43 / $1,249.22 / $1,727.67
| Professional | | $816.43 | $1,249.22 | $1,727.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.83 / $1,166.06 / $1,788.80
| Professional | | $1,007.83 | $1,166.06 | $1,788.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.35 / $1,070.96 / $1,108.48
| Professional | | $667.35 | $1,070.96 | $1,108.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.93 / $1,300.15 / $1,625.19
| Professional | | $813.93 | $1,300.15 | $1,625.19 |