- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.39 / $650.61 / $1,283.55
| Professional | | $475.39 | $650.61 | $1,283.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.47 / $759.58 / $910.51
| Professional | | $351.47 | $759.58 | $910.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.52 / $706.79 / $1,482.74
| Professional | | $356.52 | $706.79 | $1,482.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.40 / $714.08 / $861.18
| Professional | | $430.40 | $714.08 | $861.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.03 / $711.97 / $1,720.36
| Professional | | $516.03 | $711.97 | $1,720.36 |