- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.02 / $315.25 / $504.59
| Professional | | $207.02 | $315.25 | $504.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.22 / $615.15 / $1,126.70
| Professional | | $363.22 | $615.15 | $1,126.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.49 / $785.67 / $1,447.37
| Professional | | $457.49 | $785.67 | $1,447.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.69 / $731.87 / $1,365.44
| Professional | | $462.69 | $731.87 | $1,365.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.80 / $819.92 / $1,586.26
| Professional | | $465.80 | $819.92 | $1,586.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.87 / $709.12 / $1,447.66
| Professional | | $444.87 | $709.12 | $1,447.66 |