- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.46 / $915.36 / $1,095.22
| Professional | | $727.46 | $915.36 | $1,095.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.58 / $1,183.57 / $1,680.76
| Professional | | $914.58 | $1,183.57 | $1,680.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $897.53 / $1,314.27 / $1,882.24
| Professional | | $897.53 | $1,314.27 | $1,882.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.69 / $1,270.03 / $1,948.29
| Professional | | $1,097.69 | $1,270.03 | $1,948.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.46 / $999.29 / $1,095.22
| Professional | | $727.46 | $999.29 | $1,095.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.25 / $1,177.15 / $1,868.19
| Professional | | $830.25 | $1,177.15 | $1,868.19 |