- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.65 / $590.36 / $590.36
| Professional | | $511.65 | $590.36 | $590.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.72 / $724.18 / $825.57
| Professional | | $629.72 | $724.18 | $825.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.19 / $417.19 / $417.19
| Professional | | $417.19 | $417.19 | $417.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.15 / $905.22 / $1,180.73
| Professional | | $787.15 | $905.22 | $1,180.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.60 / $354.22 / $716.29
| Professional | | $330.60 | $354.22 | $716.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.58 / $393.58 / $393.58
| Professional | | $393.58 | $393.58 | $393.58 |