- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.58 / $385.61 / $1,499.93
| Professional | | $282.58 | $385.61 | $1,499.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.16 / $512.16 / $1,433.94
| Professional | | $512.16 | $512.16 | $1,433.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.37 / $525.49 / $1,433.94
| Professional | | $298.37 | $525.49 | $1,433.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.97 / $559.29 / $1,433.94
| Professional | | $376.97 | $559.29 | $1,433.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.75 / $548.74 / $1,595.24
| Professional | | $450.75 | $548.74 | $1,595.24 |