- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.17 / $380.54 / $560.41
| Professional | | $272.17 | $380.54 | $560.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.35 / $509.35 / $1,691.35
| Professional | | $509.35 | $509.35 | $1,691.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.55 / $619.30 / $1,074.02
| Professional | | $409.55 | $619.30 | $1,074.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.83 / $647.67 / $1,074.02
| Professional | | $428.83 | $647.67 | $1,074.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.23 / $663.59 / $1,961.04
| Professional | | $515.23 | $663.59 | $1,961.04 |