- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $1,047.13
| Professional | | $354.81 | $436.52 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $851.14
| Professional | | $389.05 | $575.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $870.96
| Professional | | $436.52 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $575.44 / $1,096.48
| Professional | | $478.63 | $575.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $1,174.90
| Professional | | $371.54 | $537.03 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $512.86 / $851.14
| Professional | | $338.84 | $512.86 | $851.14 |