- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.77 / $422.03 / $923.87
| Professional | | $283.77 | $422.03 | $923.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.01 / $473.55 / $1,015.36
| Professional | | $278.01 | $473.55 | $1,015.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.20 / $725.43 / $1,188.51
| Professional | | $323.20 | $725.43 | $1,188.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.51 / $450.93 / $2,213.85
| Professional | | $315.51 | $450.93 | $2,213.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.90 / $462.30 / $757.57
| Professional | | $359.90 | $462.30 | $757.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.07 / $590.08 / $1,052.47
| Professional | | $332.07 | $590.08 | $1,052.47 |