- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.64 / $482.56 / $673.41
| Professional | | $328.64 | $482.56 | $673.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.52 / $649.52 / $2,068.69
| Professional | | $649.52 | $649.52 | $2,068.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.52 / $760.11 / $1,307.49
| Professional | | $508.52 | $760.11 | $1,307.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.11 / $775.42 / $1,307.49
| Professional | | $524.11 | $775.42 | $1,307.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.71 / $713.41 / $1,303.61
| Professional | | $598.71 | $713.41 | $1,303.61 |