- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.90 / $379.91 / $570.83
| Professional | | $376.90 | $379.91 | $570.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.72 / $596.13 / $1,769.22
| Professional | | $505.72 | $596.13 | $1,769.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.72 / $640.84 / $1,106.39
| Professional | | $423.72 | $640.84 | $1,106.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.95 / $645.30 / $1,106.39
| Professional | | $432.95 | $645.30 | $1,106.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.96 / $683.59 / $2,020.14
| Professional | | $498.96 | $683.59 | $2,020.14 |