- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.51 / $459.54 / $510.95
| Professional | | $364.51 | $459.54 | $510.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.82 / $925.12 / $1,399.44
| Professional | | $784.82 | $925.12 | $1,399.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.55 / $684.16 / $889.65
| Professional | | $515.55 | $684.16 | $889.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.55 / $638.41 / $889.65
| Professional | | $515.55 | $638.41 | $889.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.67 / $608.12 / $1,624.42
| Professional | | $549.67 | $608.12 | $1,624.42 |