- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.04 / $583.33 / $900.28
| Professional | | $482.04 | $583.33 | $900.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.83 / $747.78 / $1,072.32
| Professional | | $577.83 | $747.78 | $1,072.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.38 / $834.57 / $1,193.52
| Professional | | $576.38 | $834.57 | $1,193.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.33 / $810.28 / $1,243.02
| Professional | | $700.33 | $810.28 | $1,243.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.71 / $605.50 / $689.06
| Professional | | $457.71 | $605.50 | $689.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.55 / $723.72 / $1,116.53
| Professional | | $468.55 | $723.72 | $1,116.53 |