- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.64 / $362.69 / $1,227.97
| Professional | | $199.64 | $362.69 | $1,227.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.50 / $405.02 / $725.03
| Professional | | $213.50 | $405.02 | $725.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.08 / $653.86 / $1,215.94
| Professional | | $319.08 | $653.86 | $1,215.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.65 / $905.32 / $3,990.72
| Professional | | $507.65 | $905.32 | $3,990.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.61 / $689.75 / $1,050.85
| Professional | | $479.61 | $689.75 | $1,050.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.65 / $917.61 / $978.64
| Professional | | $507.65 | $917.61 | $978.64 |