- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.06 / $377.77 / $432.61
| Professional | | $272.06 | $377.77 | $432.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.83 / $491.35 / $1,345.17
| Professional | | $416.83 | $491.35 | $1,345.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.38 / $565.91 / $809.45
| Professional | | $366.38 | $565.91 | $809.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.65 / $534.21 / $809.45
| Professional | | $438.65 | $534.21 | $809.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.90 / $506.05 / $1,477.98
| Professional | | $414.90 | $506.05 | $1,477.98 |