- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.28 / $350.63 / $1,227.17
| Professional | | $201.28 | $350.63 | $1,227.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.70 / $583.29 / $870.29
| Professional | | $357.70 | $583.29 | $870.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.78 / $540.15 / $734.59
| Professional | | $398.78 | $540.15 | $734.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.13 / $506.63 / $819.29
| Professional | | $348.13 | $506.63 | $819.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.60 / $587.16 / $857.67
| Professional | | $393.60 | $587.16 | $857.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.73 / $570.40 / $846.12
| Professional | | $389.73 | $570.40 | $846.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.54 / $756.81 / $991.22
| Professional | | $539.54 | $756.81 | $991.22 |