- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.52 / $840.07 / $1,085.84
| Professional | | $787.52 | $840.07 | $1,085.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.27 / $1,168.94 / $1,658.95
| Professional | | $903.27 | $1,168.94 | $1,658.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.28 / $1,303.02 / $1,857.75
| Professional | | $884.28 | $1,303.02 | $1,857.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,083.26 / $1,253.33 / $1,922.68
| Professional | | $1,083.26 | $1,253.33 | $1,922.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.05 / $791.33 / $1,085.84
| Professional | | $724.05 | $791.33 | $1,085.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.25 / $1,198.38 / $1,721.82
| Professional | | $825.25 | $1,198.38 | $1,721.82 |