- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.14 / $692.86 / $1,070.09
| Professional | | $365.14 | $692.86 | $1,070.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.96 / $617.75 / $915.42
| Professional | | $446.96 | $617.75 | $915.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.04 / $857.69 / $1,039.61
| Professional | | $602.04 | $857.69 | $1,039.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $840.04 / $936.04
| Professional | | $32.34 | $840.04 | $936.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.64 / $865.39 / $1,081.83
| Professional | | $635.64 | $865.39 | $1,081.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.16 / $772.57 / $1,107.78
| Professional | | $533.16 | $772.57 | $1,107.78 |