- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $524.81 / $1,258.93
| Professional | | $389.05 | $524.81 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $776.25
| Professional | | $660.69 | $660.69 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $676.08 / $1,047.13
| Professional | | $371.54 | $676.08 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $831.76
| Professional | | $478.63 | $630.96 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $660.69 / $1,905.46
| Professional | | $537.03 | $660.69 | $1,905.46 |