- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.39 / $838.60 / $1,006.62
| Professional | | $667.39 | $838.60 | $1,006.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.98 / $1,084.44 / $1,543.17
| Professional | | $837.98 | $1,084.44 | $1,543.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.89 / $1,207.94 / $1,724.65
| Professional | | $823.89 | $1,207.94 | $1,724.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.83 / $1,166.06 / $1,788.80
| Professional | | $1,007.83 | $1,166.06 | $1,788.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.39 / $903.46 / $1,006.62
| Professional | | $667.39 | $903.46 | $1,006.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.59 / $1,070.43 / $1,600.97
| Professional | | $764.59 | $1,070.43 | $1,600.97 |