- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.05 / $390.09 / $590.70
| Professional | | $279.05 | $390.09 | $590.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.80 / $786.00 / $1,752.94
| Professional | | $666.80 | $786.00 | $1,752.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.70 / $638.47 / $1,120.44
| Professional | | $415.70 | $638.47 | $1,120.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.57 / $680.09 / $1,120.44
| Professional | | $435.57 | $680.09 | $1,120.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.87 / $703.74 / $2,045.82
| Professional | | $550.87 | $703.74 | $2,045.82 |