- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.18 / $496.90 / $513.21
| Professional | | $367.18 | $496.90 | $513.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.08 / $418.08 / $1,491.64
| Professional | | $418.08 | $418.08 | $1,491.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.54 / $717.48 / $936.17
| Professional | | $464.54 | $717.48 | $936.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.11 / $625.92 / $936.17
| Professional | | $435.11 | $625.92 | $936.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.20 / $598.55 / $1,709.36
| Professional | | $564.20 | $598.55 | $1,709.36 |