- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.66 / $431.73 / $501.74
| Professional | | $391.66 | $431.73 | $501.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.86 / $530.04 / $804.43
| Professional | | $452.86 | $530.04 | $804.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.41 / $682.57 / $1,055.16
| Professional | | $379.41 | $682.57 | $1,055.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.47 / $731.40 / $1,083.52
| Professional | | $610.47 | $731.40 | $1,083.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.66 / $431.73 / $501.74
| Professional | | $391.66 | $431.73 | $501.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.87 / $569.66 / $859.41
| Professional | | $392.87 | $569.66 | $859.41 |