- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.72 / $868.01 / $1,112.14
| Professional | | $744.72 | $868.01 | $1,112.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.96 / $1,193.11 / $1,731.25
| Professional | | $921.96 | $1,193.11 | $1,731.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.52 / $1,351.05 / $2,006.74
| Professional | | $935.52 | $1,351.05 | $2,006.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,130.66 / $1,308.17 / $2,006.81
| Professional | | $1,130.66 | $1,308.17 | $2,006.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.72 / $868.01 / $1,112.14
| Professional | | $744.72 | $868.01 | $1,112.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.72 / $1,148.64 / $1,833.29
| Professional | | $814.72 | $1,148.64 | $1,833.29 |