- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.12 / $486.20 / $667.85
| Professional | | $323.12 | $486.20 | $667.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.68 / $606.39 / $828.04
| Professional | | $368.68 | $606.39 | $828.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.57 / $794.99 / $1,471.17
| Professional | | $505.57 | $794.99 | $1,471.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.96 / $828.63 / $1,486.13
| Professional | | $455.96 | $828.63 | $1,486.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.55 / $801.98 / $3,372.72
| Professional | | $570.55 | $801.98 | $3,372.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.66 / $394.32 / $500.77
| Professional | | $281.66 | $394.32 | $500.77 |