- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.93 / $628.79 / $820.81
| Professional | | $461.93 | $628.79 | $820.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.38 / $631.36 / $814.37
| Professional | | $546.38 | $631.36 | $814.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.23 / $814.37 / $1,641.91
| Professional | | $433.23 | $814.37 | $1,641.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.16 / $809.61 / $1,104.02
| Professional | | $521.16 | $809.61 | $1,104.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.52 / $560.90 / $1,140.82
| Professional | | $311.52 | $560.90 | $1,140.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.48 / $838.13 / $1,047.66
| Professional | | $461.48 | $838.13 | $1,047.66 |