- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.55 / $396.47 / $752.01
| Professional | | $286.55 | $396.47 | $752.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.62 / $554.40 / $1,698.90
| Professional | | $456.62 | $554.40 | $1,698.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.76 / $430.82 / $1,118.33
| Professional | | $300.76 | $430.82 | $1,118.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.42 / $566.91 / $1,118.33
| Professional | | $392.42 | $566.91 | $1,118.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.04 / $519.66 / $1,612.62
| Professional | | $416.04 | $519.66 | $1,612.62 |