- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.19 / $336.84 / $504.16
| Professional | | $241.19 | $336.84 | $504.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.36 / $684.12 / $1,483.65
| Professional | | $580.36 | $684.12 | $1,483.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.98 / $542.39 / $956.25
| Professional | | $353.98 | $542.39 | $956.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.21 / $581.23 / $956.25
| Professional | | $376.21 | $581.23 | $956.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.91 / $600.60 / $1,745.99
| Professional | | $452.91 | $600.60 | $1,745.99 |