- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.62 / $373.01 / $415.17
| Professional | | $268.62 | $373.01 | $415.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.97 / $491.52 / $1,288.75
| Professional | | $416.97 | $491.52 | $1,288.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.91 / $550.84 / $779.82
| Professional | | $353.91 | $550.84 | $779.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.03 / $514.74 / $779.82
| Professional | | $429.03 | $514.74 | $779.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.50 / $489.79 / $1,423.85
| Professional | | $409.50 | $489.79 | $1,423.85 |