- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.89 / $448.66 / $591.66
| Professional | | $348.89 | $448.66 | $591.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.06 / $503.14 / $778.73
| Professional | | $383.06 | $503.14 | $778.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.34 / $590.04 / $1,039.22
| Professional | | $416.34 | $590.04 | $1,039.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.80 / $693.83 / $5,098.60
| Professional | | $471.80 | $693.83 | $5,098.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.28 / $548.22 / $1,007.85
| Professional | | $448.28 | $548.22 | $1,007.85 |