- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.91 / $480.25 / $635.63
| Professional | | $384.91 | $480.25 | $635.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.24 / $860.24 / $1,030.66
| Professional | | $860.24 | $860.24 | $1,030.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.66 / $600.30 / $617.32
| Professional | | $308.66 | $600.30 | $617.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.19 / $296.63 / $1,624.38
| Professional | | $247.19 | $296.63 | $1,624.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.69 / $423.75 / $423.75
| Professional | | $190.69 | $423.75 | $423.75 |