- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $363.08 / $870.96
| Professional | | $257.04 | $363.08 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $478.63 / $1,023.29
| Professional | | $275.42 | $478.63 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $660.69
| Professional | | $346.74 | $478.63 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $457.09 / $1,096.48
| Professional | | $234.42 | $457.09 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $371.54 / $891.25
| Professional | | $229.09 | $371.54 | $891.25 |