- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.07 / $692.41 / $1,272.88
| Professional | | $529.07 | $692.41 | $1,272.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.55 / $852.31 / $1,269.52
| Professional | | $712.55 | $852.31 | $1,269.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.35 / $1,075.14 / $1,583.39
| Professional | | $616.35 | $1,075.14 | $1,583.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.15 / $993.15 / $1,641.26
| Professional | | $809.15 | $993.15 | $1,641.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.07 / $718.48 / $1,272.88
| Professional | | $529.07 | $718.48 | $1,272.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.25 / $1,113.27 / $1,578.84
| Professional | | $767.25 | $1,113.27 | $1,578.84 |