- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.88 / $940.12 / $1,054.84
| Professional | | $714.88 | $940.12 | $1,054.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.13 / $1,127.34 / $1,647.31
| Professional | | $871.13 | $1,127.34 | $1,647.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.43 / $1,286.40 / $1,910.43
| Professional | | $891.43 | $1,286.40 | $1,910.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.83 / $1,244.75 / $1,909.51
| Professional | | $1,075.83 | $1,244.75 | $1,909.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.88 / $943.35 / $1,054.84
| Professional | | $714.88 | $943.35 | $1,054.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.40 / $1,088.08 / $1,745.26
| Professional | | $734.40 | $1,088.08 | $1,745.26 |