- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.65 / $857.38 / $1,025.56
| Professional | | $682.65 | $857.38 | $1,025.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.04 / $1,109.10 / $1,577.88
| Professional | | $857.04 | $1,109.10 | $1,577.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $842.14 / $1,230.67 / $1,763.69
| Professional | | $842.14 | $1,230.67 | $1,763.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.50 / $1,192.29 / $1,829.03
| Professional | | $1,030.50 | $1,192.29 | $1,829.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.65 / $942.46 / $1,025.56
| Professional | | $682.65 | $942.46 | $1,025.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.43 / $1,122.02 / $1,637.49
| Professional | | $779.43 | $1,122.02 | $1,637.49 |