- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $954.99
| Professional | | $309.03 | $467.74 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $1,737.80
| Professional | | $537.03 | $537.03 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $616.60 / $1,737.80
| Professional | | $331.13 | $616.60 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $660.69 / $1,230.27
| Professional | | $489.78 | $660.69 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $1,096.48
| Professional | | $354.81 | $501.19 | $1,096.48 |