- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.18 / $367.88 / $546.88
| Professional | | $263.18 | $367.88 | $546.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.46 / $727.85 / $1,521.60
| Professional | | $617.46 | $727.85 | $1,521.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.54 / $572.02 / $979.65
| Professional | | $376.54 | $572.02 | $979.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.12 / $618.88 / $979.65
| Professional | | $432.12 | $618.88 | $979.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.82 / $615.29 / $1,788.72
| Professional | | $528.82 | $615.29 | $1,788.72 |