- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.24 / $329.27 / $491.41
| Professional | | $236.24 | $329.27 | $491.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.55 / $643.10 / $1,489.08
| Professional | | $545.55 | $643.10 | $1,489.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.89 / $541.76 / $943.37
| Professional | | $356.89 | $541.76 | $943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.55 / $561.90 / $943.37
| Professional | | $367.55 | $561.90 | $943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.16 / $592.51 / $1,722.46
| Professional | | $437.16 | $592.51 | $1,722.46 |