- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.48 / $336.21 / $510.45
| Professional | | $317.48 | $336.21 | $510.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.72 / $483.72 / $1,533.84
| Professional | | $483.72 | $483.72 | $1,533.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.36 / $554.62 / $974.62
| Professional | | $360.36 | $554.62 | $974.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.26 / $586.52 / $974.62
| Professional | | $374.26 | $586.52 | $974.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.91 / $602.17 / $1,779.56
| Professional | | $474.91 | $602.17 | $1,779.56 |