- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.57 / $683.64 / $887.37
| Professional | | $452.57 | $683.64 | $887.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.47 / $764.14 / $1,212.38
| Professional | | $750.47 | $764.14 | $1,212.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.51 / $568.34 / $1,212.38
| Professional | | $441.51 | $568.34 | $1,212.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.26 / $568.34 / $1,212.38
| Professional | | $342.26 | $568.34 | $1,212.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.14 / $888.76 / $1,369.24
| Professional | | $400.14 | $888.76 | $1,369.24 |