- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.98 / $920.22 / $1,105.44
| Professional | | $807.98 | $920.22 | $1,105.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.52 / $1,189.96 / $1,693.38
| Professional | | $919.52 | $1,189.96 | $1,693.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.07 / $1,326.53 / $1,892.52
| Professional | | $904.07 | $1,326.53 | $1,892.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,105.93 / $1,279.56 / $1,962.92
| Professional | | $1,105.93 | $1,279.56 | $1,962.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.98 / $992.87 / $1,407.98
| Professional | | $807.98 | $992.87 | $1,407.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.14 / $1,206.17 / $1,758.07
| Professional | | $840.14 | $1,206.17 | $1,758.07 |