- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.36 / $510.87 / $951.33
| Professional | | $381.36 | $510.87 | $951.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.19 / $770.25 / $1,154.69
| Professional | | $595.19 | $770.25 | $1,154.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.39 / $848.55 / $1,218.46
| Professional | | $603.39 | $848.55 | $1,218.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.30 / $840.33 / $1,289.10
| Professional | | $726.30 | $840.33 | $1,289.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.36 / $656.21 / $951.33
| Professional | | $381.36 | $656.21 | $951.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.66 / $679.17 / $1,289.10
| Professional | | $512.66 | $679.17 | $1,289.10 |