- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.47 / $508.55 / $532.17
| Professional | | $429.47 | $508.55 | $532.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.07 / $556.46 / $1,635.88
| Professional | | $472.07 | $556.46 | $1,635.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.09 / $696.83 / $996.41
| Professional | | $491.09 | $696.83 | $996.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.88 / $659.99 / $996.41
| Professional | | $458.88 | $659.99 | $996.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.92 / $615.64 / $1,819.33
| Professional | | $475.92 | $615.64 | $1,819.33 |