- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.13 / $961.85 / $1,158.94
| Professional | | $768.13 | $961.85 | $1,158.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.64 / $1,247.07 / $1,769.74
| Professional | | $963.64 | $1,247.07 | $1,769.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.03 / $1,390.72 / $1,981.08
| Professional | | $943.03 | $1,390.72 | $1,981.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,155.81 / $1,337.27 / $2,051.44
| Professional | | $1,155.81 | $1,337.27 | $2,051.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.13 / $1,021.41 / $1,158.94
| Professional | | $768.13 | $1,021.41 | $1,158.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.08 / $1,112.57 / $1,834.90
| Professional | | $788.08 | $1,112.57 | $1,834.90 |