- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.45 / $499.12 / $1,057.45
| Professional | | $261.45 | $499.12 | $1,057.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.55 / $616.88 / $1,144.30
| Professional | | $360.55 | $616.88 | $1,144.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.54 / $684.06 / $1,240.38
| Professional | | $353.54 | $684.06 | $1,240.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.41 / $696.49 / $1,333.14
| Professional | | $392.41 | $696.49 | $1,333.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.44 / $499.12 / $1,104.25
| Professional | | $261.44 | $499.12 | $1,104.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.37 / $845.67 / $1,302.27
| Professional | | $593.37 | $845.67 | $1,302.27 |