- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.23 / $421.52 / $469.90
| Professional | | $405.23 | $421.52 | $469.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.91 / $474.91 / $1,466.53
| Professional | | $474.91 | $474.91 | $1,466.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.66 / $597.91 / $869.73
| Professional | | $389.66 | $597.91 | $869.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.27 / $563.28 / $869.73
| Professional | | $430.27 | $563.28 | $869.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.73 / $546.27 / $1,588.03
| Professional | | $453.73 | $546.27 | $1,588.03 |