- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.68 / $377.83 / $633.57
| Professional | | $244.68 | $377.83 | $633.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.61 / $548.32 / $1,680.27
| Professional | | $451.61 | $548.32 | $1,680.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.14 / $523.69 / $1,392.16
| Professional | | $330.14 | $523.69 | $1,392.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.25 / $566.88 / $1,392.16
| Professional | | $345.25 | $566.88 | $1,392.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.72 / $546.99 / $1,590.15
| Professional | | $397.72 | $546.99 | $1,590.15 |