- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.61 / $480.53 / $985.62
| Professional | | $346.61 | $480.53 | $985.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.86 / $376.86 / $531.20
| Professional | | $376.86 | $376.86 | $531.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.15 / $566.13 / $1,126.95
| Professional | | $362.15 | $566.13 | $1,126.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.25 / $714.98 / $950.35
| Professional | | $554.25 | $714.98 | $950.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.73 / $572.53 / $1,109.16
| Professional | | $388.73 | $572.53 | $1,109.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.93 / $637.39 / $789.75
| Professional | | $366.93 | $637.39 | $789.75 |