- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $1,380.38
| Professional | | $354.81 | $467.74 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $489.78 / $562.34
| Professional | | $436.52 | $489.78 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $933.25
| Professional | | $398.11 | $524.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $1,148.15
| Professional | | $501.19 | $602.56 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $933.25
| Professional | | $371.54 | $524.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $851.14
| Professional | | $416.87 | $549.54 | $851.14 |