- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.29 / $472.71 / $908.88
| Professional | | $348.29 | $472.71 | $908.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.44 / $651.30 / $1,995.87
| Professional | | $536.44 | $651.30 | $1,995.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.28 / $526.02 / $1,340.25
| Professional | | $375.28 | $526.02 | $1,340.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.62 / $680.80 / $1,340.25
| Professional | | $478.62 | $680.80 | $1,340.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.06 / $652.08 / $1,895.64
| Professional | | $489.06 | $652.08 | $1,895.64 |