- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.93 / $476.56 / $480.31
| Professional | | $374.93 | $476.56 | $480.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.51 / $837.69 / $1,044.13
| Professional | | $682.51 | $837.69 | $1,044.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $870.06 / $1,342.86
| Professional | | $436.52 | $870.06 | $1,342.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.93 / $912.87 / $1,258.44
| Professional | | $487.93 | $912.87 | $1,258.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.93 / $875.07 / $1,258.44
| Professional | | $487.93 | $875.07 | $1,258.44 |