- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.56 / $948.90 / $1,137.02
| Professional | | $754.56 | $948.90 | $1,137.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.81 / $1,227.86 / $1,742.61
| Professional | | $948.81 | $1,227.86 | $1,742.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.06 / $1,364.42 / $1,952.04
| Professional | | $930.06 | $1,364.42 | $1,952.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.08 / $1,316.76 / $2,019.98
| Professional | | $1,138.08 | $1,316.76 | $2,019.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.56 / $1,012.07 / $1,137.02
| Professional | | $754.56 | $1,012.07 | $1,137.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.18 / $1,236.25 / $1,616.74
| Professional | | $773.18 | $1,236.25 | $1,616.74 |