- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.86 / $956.74 / $1,076.78
| Professional | | $729.86 | $956.74 | $1,076.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.34 / $1,152.20 / $1,676.34
| Professional | | $890.34 | $1,152.20 | $1,676.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.94 / $1,308.27 / $1,946.21
| Professional | | $905.94 | $1,308.27 | $1,946.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.80 / $1,266.68 / $1,943.16
| Professional | | $1,094.80 | $1,266.68 | $1,943.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.86 / $960.15 / $1,076.78
| Professional | | $729.86 | $960.15 | $1,076.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.70 / $1,112.07 / $1,703.51
| Professional | | $817.70 | $1,112.07 | $1,703.51 |