- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.51 / $403.52 / $456.82
| Professional | | $290.51 | $403.52 | $456.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.21 / $535.41 / $1,422.42
| Professional | | $454.21 | $535.41 | $1,422.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.99 / $596.96 / $857.49
| Professional | | $385.99 | $596.96 | $857.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.11 / $566.16 / $857.49
| Professional | | $463.11 | $566.16 | $857.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.02 / $538.58 / $1,565.69
| Professional | | $447.02 | $538.58 | $1,565.69 |