- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.68 / $501.62 / $547.65
| Professional | | $377.68 | $501.62 | $547.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.07 / $503.09 / $1,512.94
| Professional | | $423.07 | $503.09 | $1,512.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.35 / $728.16 / $946.68
| Professional | | $467.35 | $728.16 | $946.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.46 / $637.11 / $946.68
| Professional | | $439.46 | $637.11 | $946.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.42 / $594.59 / $1,728.53
| Professional | | $488.42 | $594.59 | $1,728.53 |