- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.69 / $410.04 / $737.42
| Professional | | $287.69 | $410.04 | $737.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.86 / $614.20 / $1,882.09
| Professional | | $505.86 | $614.20 | $1,882.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.15 / $575.21 / $1,539.17
| Professional | | $382.15 | $575.21 | $1,539.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.56 / $627.65 / $1,539.17
| Professional | | $400.56 | $627.65 | $1,539.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.51 / $533.05 / $1,769.47
| Professional | | $456.51 | $533.05 | $1,769.47 |