- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.40 / $969.88 / $1,090.50
| Professional | | $729.40 | $969.88 | $1,090.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.12 / $1,164.85 / $1,678.86
| Professional | | $900.12 | $1,164.85 | $1,678.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.61 / $1,313.30 / $1,965.20
| Professional | | $911.61 | $1,313.30 | $1,965.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.45 / $1,268.58 / $1,946.09
| Professional | | $1,096.45 | $1,268.58 | $1,946.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.40 / $981.65 / $1,090.50
| Professional | | $729.40 | $981.65 | $1,090.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.67 / $1,147.92 / $1,589.10
| Professional | | $791.67 | $1,147.92 | $1,589.10 |