- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.23 / $420.73 / $606.65
| Professional | | $300.23 | $420.73 | $606.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.91 / $612.87 / $1,744.11
| Professional | | $519.91 | $612.87 | $1,744.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.33 / $703.18 / $1,134.13
| Professional | | $446.33 | $703.18 | $1,134.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.57 / $722.56 / $1,134.13
| Professional | | $486.57 | $722.56 | $1,134.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.04 / $712.33 / $2,070.81
| Professional | | $654.04 | $712.33 | $2,070.81 |