- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.64 / $458.39 / $714.33
| Professional | | $324.64 | $458.39 | $714.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.53 / $934.19 / $1,624.74
| Professional | | $591.53 | $934.19 | $1,624.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.40 / $1,228.39 / $2,048.76
| Professional | | $770.40 | $1,228.39 | $2,048.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.46 / $1,116.72 / $1,925.68
| Professional | | $701.46 | $1,116.72 | $1,925.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.45 / $965.32 / $2,667.28
| Professional | | $545.45 | $965.32 | $2,667.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.49 / $842.96 / $1,796.75
| Professional | | $541.49 | $842.96 | $1,796.75 |