- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.04 / $470.29 / $789.37
| Professional | | $323.04 | $470.29 | $789.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.82 / $589.11 / $925.74
| Professional | | $382.82 | $589.11 | $925.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.77 / $593.30 / $952.34
| Professional | | $410.77 | $593.30 | $952.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,736.32 / $3,879.12 / $4,479.45
| Professional | | $2,736.32 | $3,879.12 | $4,479.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.22 / $574.04 / $1,071.69
| Professional | | $459.22 | $574.04 | $1,071.69 |