- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.14 / $430.23 / $539.96
| Professional | | $365.14 | $430.23 | $539.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.22 / $498.40 / $684.37
| Professional | | $347.22 | $498.40 | $684.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.02 / $538.07 / $751.86
| Professional | | $389.02 | $538.07 | $751.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.26 / $565.72 / $4,012.88
| Professional | | $447.26 | $565.72 | $4,012.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.21 / $529.65 / $761.77
| Professional | | $432.21 | $529.65 | $761.77 |