- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.43 / $510.71 / $568.54
| Professional | | $402.43 | $510.71 | $568.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.87 / $641.79 / $1,026.90
| Professional | | $506.87 | $641.79 | $1,026.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.08 / $735.20 / $1,074.73
| Professional | | $544.08 | $735.20 | $1,074.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.91 / $747.33 / $1,146.44
| Professional | | $645.91 | $747.33 | $1,146.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.43 / $568.54 / $648.67
| Professional | | $402.43 | $568.54 | $648.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.40 / $645.91 / $1,008.05
| Professional | | $428.40 | $645.91 | $1,008.05 |