- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.46 / $436.46 / $437.89
| Professional | | $436.46 | $436.46 | $437.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.14 / $623.73 / $1,340.96
| Professional | | $529.14 | $623.73 | $1,340.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.81 / $607.41 / $789.38
| Professional | | $402.81 | $607.41 | $789.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.71 / $561.04 / $789.38
| Professional | | $363.71 | $561.04 | $789.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.79 / $632.71 / $1,441.31
| Professional | | $474.79 | $632.71 | $1,441.31 |