- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.97 / $939.86 / $1,126.19
| Professional | | $746.97 | $939.86 | $1,126.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.28 / $1,215.54 / $1,727.45
| Professional | | $939.28 | $1,215.54 | $1,727.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.14 / $1,351.43 / $1,933.04
| Professional | | $922.14 | $1,351.43 | $1,933.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.19 / $1,305.32 / $2,002.42
| Professional | | $1,128.19 | $1,305.32 | $2,002.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.97 / $1,023.14 / $1,126.19
| Professional | | $746.97 | $1,023.14 | $1,126.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.40 / $1,207.59 / $2,002.42
| Professional | | $773.40 | $1,207.59 | $2,002.42 |