- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.83 / $392.66 / $612.01
| Professional | | $280.83 | $392.66 | $612.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.51 / $746.78 / $1,939.78
| Professional | | $633.51 | $746.78 | $1,939.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.09 / $647.49 / $1,155.14
| Professional | | $444.09 | $647.49 | $1,155.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.09 / $691.50 / $1,155.14
| Professional | | $444.09 | $691.50 | $1,155.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.72 / $725.52 / $2,109.14
| Professional | | $541.72 | $725.52 | $2,109.14 |