- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.19 / $257.47 / $408.15
| Professional | | $166.19 | $257.47 | $408.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.67 / $589.54 / $971.33
| Professional | | $337.67 | $589.54 | $971.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.88 / $659.71 / $1,165.38
| Professional | | $379.88 | $659.71 | $1,165.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.12 / $589.28 / $1,062.65
| Professional | | $376.12 | $589.28 | $1,062.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.64 / $559.80 / $1,306.48
| Professional | | $297.64 | $559.80 | $1,306.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.64 / $508.40 / $1,041.97
| Professional | | $297.64 | $508.40 | $1,041.97 |