- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $537.03 / $1,122.02
| Professional | | $389.05 | $537.03 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $691.83 / $977.24
| Professional | | $467.74 | $691.83 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $630.96 / $1,122.02
| Professional | | $562.34 | $630.96 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $707.95 / $1,023.29
| Professional | | $575.44 | $707.95 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $1,348.96
| Professional | | $389.05 | $588.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $691.83 / $1,096.48
| Professional | | $501.19 | $691.83 | $1,096.48 |