- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.81 / $466.45 / $760.63
| Professional | | $352.81 | $466.45 | $760.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.43 / $877.52 / $1,702.60
| Professional | | $744.43 | $877.52 | $1,702.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.07 / $632.10 / $818.27
| Professional | | $423.07 | $632.10 | $818.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.07 / $631.33 / $818.27
| Professional | | $423.07 | $631.33 | $818.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.29 / $630.41 / $1,912.24
| Professional | | $537.29 | $630.41 | $1,912.24 |