- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.81 / $393.31 / $513.87
| Professional | | $277.81 | $393.31 | $513.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.50 / $537.27 / $1,583.03
| Professional | | $442.50 | $537.27 | $1,583.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.01 / $527.72 / $1,391.81
| Professional | | $345.01 | $527.72 | $1,391.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.88 / $568.02 / $1,391.81
| Professional | | $347.88 | $568.02 | $1,391.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.03 / $483.49 / $1,613.63
| Professional | | $403.03 | $483.49 | $1,613.63 |