- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $363.08 / $912.01
| Professional | | $257.04 | $363.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $416.87 / $1,148.15
| Professional | | $354.81 | $416.87 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $416.87 / $616.60
| Professional | | $263.03 | $416.87 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $537.03
| Professional | | $316.23 | $426.58 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $741.31
| Professional | | $316.23 | $398.11 | $741.31 |