- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.67 / $331.26 / $475.59
| Professional | | $212.67 | $331.26 | $475.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.31 / $569.72 / $895.78
| Professional | | $433.31 | $569.72 | $895.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.35 / $689.89 / $1,228.93
| Professional | | $412.35 | $689.89 | $1,228.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.46 / $832.95 / $3,990.72
| Professional | | $442.46 | $832.95 | $3,990.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.19 / $613.02 / $1,148.20
| Professional | | $433.19 | $613.02 | $1,148.20 |