- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.69 / $364.08 / $530.97
| Professional | | $346.69 | $364.08 | $530.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.66 / $691.55 / $1,610.69
| Professional | | $586.66 | $691.55 | $1,610.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.46 / $587.47 / $1,030.50
| Professional | | $390.46 | $587.47 | $1,030.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.18 / $620.11 / $1,030.50
| Professional | | $404.18 | $620.11 | $1,030.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.61 / $647.23 / $1,881.56
| Professional | | $487.61 | $647.23 | $1,881.56 |