- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.55 / $423.07 / $625.85
| Professional | | $282.55 | $423.07 | $625.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.42 / $532.42 / $1,902.89
| Professional | | $532.42 | $532.42 | $1,902.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.90 / $573.07 / $1,147.77
| Professional | | $419.90 | $573.07 | $1,147.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.94 / $640.75 / $1,147.77
| Professional | | $433.94 | $640.75 | $1,147.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.71 / $720.89 / $2,095.67
| Professional | | $441.71 | $720.89 | $2,095.67 |