- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.13 / $501.66 / $549.41
| Professional | | $402.13 | $501.66 | $549.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.27 / $851.75 / $1,194.23
| Professional | | $600.27 | $851.75 | $1,194.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.47 / $770.90 / $1,618.10
| Professional | | $548.47 | $770.90 | $1,618.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.38 / $857.67 / $1,609.24
| Professional | | $521.38 | $857.67 | $1,609.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.03 / $604.57 / $951.61
| Professional | | $329.03 | $604.57 | $951.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.89 / $205.58 / $261.64
| Professional | | $186.89 | $205.58 | $261.64 |