- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.63 / $410.71 / $573.71
| Professional | | $293.63 | $410.71 | $573.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.01 / $568.01 / $1,727.31
| Professional | | $568.01 | $568.01 | $1,727.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.74 / $636.30 / $1,100.71
| Professional | | $444.74 | $636.30 | $1,100.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.22 / $667.98 / $1,100.71
| Professional | | $460.22 | $667.98 | $1,100.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.00 / $691.33 / $2,009.76
| Professional | | $530.00 | $691.33 | $2,009.76 |