- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.41 / $563.42 / $880.45
| Professional | | $426.41 | $563.42 | $880.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.01 / $809.83 / $1,975.60
| Professional | | $687.01 | $809.83 | $1,975.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.60 / $704.76 / $947.07
| Professional | | $455.60 | $704.76 | $947.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.60 / $686.08 / $906.69
| Professional | | $455.60 | $686.08 | $906.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.47 / $703.17 / $2,132.71
| Professional | | $580.47 | $703.17 | $2,132.71 |