- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $912.01
| Professional | | $302.00 | $436.52 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $1,288.25
| Professional | | $416.87 | $416.87 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $707.95
| Professional | | $309.03 | $467.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $602.56
| Professional | | $354.81 | $478.63 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $457.09 / $831.76
| Professional | | $380.19 | $457.09 | $831.76 |