- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.44 / $823.77 / $1,246.98
| Professional | | $710.44 | $823.77 | $1,246.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.74 / $1,063.43 / $1,506.34
| Professional | | $821.74 | $1,063.43 | $1,506.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.40 / $1,185.25 / $1,692.92
| Professional | | $802.40 | $1,185.25 | $1,692.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.45 / $1,135.54 / $1,741.98
| Professional | | $981.45 | $1,135.54 | $1,741.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.63 / $987.71 / $1,463.18
| Professional | | $652.63 | $987.71 | $1,463.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.65 / $1,059.57 / $1,386.71
| Professional | | $750.65 | $1,059.57 | $1,386.71 |