- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $524.81 / $1,258.93
| Professional | | $407.38 | $524.81 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $977.24
| Professional | | $457.09 | $707.95 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $776.25 / $1,318.26
| Professional | | $512.86 | $776.25 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $724.44 / $1,174.90
| Professional | | $562.34 | $724.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $758.58 / $1,862.09
| Professional | | $407.38 | $758.58 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $741.31 / $1,148.15
| Professional | | $524.81 | $741.31 | $1,148.15 |