- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $380.19 / $831.76
| Professional | | $257.04 | $380.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $812.83
| Professional | | $323.59 | $562.34 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $588.84 / $977.24
| Professional | | $363.08 | $588.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $794.33
| Professional | | $398.11 | $562.34 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $478.63 / $954.99
| Professional | | $275.42 | $478.63 | $954.99 |