- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.79 / $460.67 / $731.79
| Professional | | $352.79 | $460.67 | $731.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.80 / $559.30 / $1,115.19
| Professional | | $272.80 | $559.30 | $1,115.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.15 / $752.53 / $856.33
| Professional | | $555.15 | $752.53 | $856.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.48 / $582.54 / $848.46
| Professional | | $385.48 | $582.54 | $848.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.84 / $534.72 / $1,039.39
| Professional | | $328.84 | $534.72 | $1,039.39 |