- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $912.01
| Professional | | $269.15 | $416.87 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $724.44 / $1,412.54
| Professional | | $346.74 | $724.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $602.56 / $1,047.13
| Professional | | $331.13 | $602.56 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $446.68 / $524.81
| Professional | | $398.11 | $446.68 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $602.56 / $977.24
| Professional | | $275.42 | $602.56 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Professional | | $4,466.84 | $4,466.84 | $4,466.84 |