- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.56 / $399.34 / $575.83
| Professional | | $285.56 | $399.34 | $575.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.91 / $722.50 / $1,766.76
| Professional | | $612.91 | $722.50 | $1,766.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.77 / $662.11 / $1,119.17
| Professional | | $433.77 | $662.11 | $1,119.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.12 / $670.90 / $1,119.17
| Professional | | $452.12 | $670.90 | $1,119.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.85 / $702.94 / $2,043.50
| Professional | | $531.85 | $702.94 | $2,043.50 |