- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.11 / $357.21 / $379.78
| Professional | | $257.11 | $357.21 | $379.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.85 / $512.59 / $1,176.33
| Professional | | $434.85 | $512.59 | $1,176.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.25 / $514.30 / $716.01
| Professional | | $334.25 | $514.30 | $716.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.81 / $475.72 / $716.01
| Professional | | $398.81 | $475.72 | $716.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.68 / $449.72 / $1,307.36
| Professional | | $369.68 | $449.72 | $1,307.36 |