- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.14 / $395.74 / $602.27
| Professional | | $277.14 | $395.74 | $602.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.52 / $884.21 / $1,351.41
| Professional | | $517.52 | $884.21 | $1,351.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.25 / $973.87 / $1,645.92
| Professional | | $586.25 | $973.87 | $1,645.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.53 / $883.05 / $1,500.83
| Professional | | $563.53 | $883.05 | $1,500.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.24 / $795.22 / $2,042.32
| Professional | | $440.24 | $795.22 | $2,042.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.24 / $722.26 / $1,492.75
| Professional | | $440.24 | $722.26 | $1,492.75 |