- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.22 / $309.14 / $471.28
| Professional | | $221.22 | $309.14 | $471.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.47 / $654.78 / $1,417.36
| Professional | | $555.47 | $654.78 | $1,417.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.46 / $508.74 / $903.91
| Professional | | $330.46 | $508.74 | $903.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.36 / $543.00 / $903.91
| Professional | | $346.36 | $543.00 | $903.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.67 / $558.48 / $1,650.43
| Professional | | $421.67 | $558.48 | $1,650.43 |