- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.73 / $433.72 / $611.86
| Professional | | $309.73 | $433.72 | $611.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.29 / $625.11 / $1,747.19
| Professional | | $530.29 | $625.11 | $1,747.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.58 / $642.12 / $1,118.29
| Professional | | $457.58 | $642.12 | $1,118.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.99 / $695.26 / $1,118.29
| Professional | | $483.99 | $695.26 | $1,118.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.51 / $690.94 / $2,041.87
| Professional | | $543.51 | $690.94 | $2,041.87 |