- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.25 / $432.79 / $470.84
| Professional | | $310.25 | $432.79 | $470.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.96 / $649.46 / $1,655.09
| Professional | | $550.96 | $649.46 | $1,655.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.20 / $643.15 / $876.71
| Professional | | $445.20 | $643.15 | $876.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.98 / $603.22 / $876.71
| Professional | | $488.98 | $603.22 | $876.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.24 / $550.65 / $1,600.77
| Professional | | $485.24 | $550.65 | $1,600.77 |