- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.08 / $365.56 / $520.34
| Professional | | $261.08 | $365.56 | $520.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.27 / $698.15 / $1,557.89
| Professional | | $592.27 | $698.15 | $1,557.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.23 / $568.64 / $996.24
| Professional | | $391.23 | $568.64 | $996.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.77 / $605.74 / $996.24
| Professional | | $407.77 | $605.74 | $996.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.24 / $625.73 / $1,051.85
| Professional | | $487.24 | $625.73 | $1,051.85 |