- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.10 / $869.14 / $1,107.46
| Professional | | $710.10 | $869.14 | $1,107.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.62 / $1,037.18 / $1,493.28
| Professional | | $807.62 | $1,037.18 | $1,493.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.71 / $1,235.97 / $1,806.14
| Professional | | $864.71 | $1,235.97 | $1,806.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.10 / $1,186.24 / $2,030.96
| Professional | | $990.10 | $1,186.24 | $2,030.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.10 / $886.72 / $1,107.46
| Professional | | $710.10 | $886.72 | $1,107.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.36 / $1,176.50 / $1,812.74
| Professional | | $840.36 | $1,176.50 | $1,812.74 |