- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.43 / $908.35 / $1,083.11
| Professional | | $718.43 | $908.35 | $1,083.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.98 / $1,169.85 / $1,668.13
| Professional | | $903.98 | $1,169.85 | $1,668.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.21 / $1,299.74 / $1,863.73
| Professional | | $893.21 | $1,299.74 | $1,863.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.44 / $1,260.48 / $1,933.65
| Professional | | $1,089.44 | $1,260.48 | $1,933.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.43 / $972.62 / $1,083.11
| Professional | | $718.43 | $972.62 | $1,083.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.94 / $1,186.97 / $1,933.65
| Professional | | $722.94 | $1,186.97 | $1,933.65 |