- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.36 / $456.43 / $818.70
| Professional | | $330.36 | $456.43 | $818.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.74 / $624.14 / $838.77
| Professional | | $471.74 | $624.14 | $838.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.16 / $313.52 / $490.50
| Professional | | $61.16 | $313.52 | $490.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.17 / $635.07 / $848.14
| Professional | | $474.17 | $635.07 | $848.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.39 / $566.67 / $924.52
| Professional | | $456.39 | $566.67 | $924.52 |