- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.05 / $434.18 / $434.18
| Professional | | $317.05 | $434.18 | $434.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.69 / $577.83 / $825.53
| Professional | | $442.69 | $577.83 | $825.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.54 / $638.42 / $1,063.85
| Professional | | $382.54 | $638.42 | $1,063.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.73 / $609.91 / $1,016.68
| Professional | | $463.73 | $609.91 | $1,016.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.05 / $317.05 / $434.18
| Professional | | $317.05 | $317.05 | $434.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.76 / $868.93 / $1,217.89
| Professional | | $514.76 | $868.93 | $1,217.89 |