- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.12 / $355.39 / $521.85
| Professional | | $254.12 | $355.39 | $521.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.12 / $643.75 / $1,578.06
| Professional | | $546.12 | $643.75 | $1,578.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.48 / $578.66 / $1,010.09
| Professional | | $383.48 | $578.66 | $1,010.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.58 / $602.91 / $1,010.09
| Professional | | $401.58 | $602.91 | $1,010.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.19 / $634.41 / $1,844.32
| Professional | | $475.19 | $634.41 | $1,844.32 |