- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $446.68 / $1,047.13
| Professional | | $338.84 | $446.68 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $645.65
| Professional | | $549.54 | $549.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $794.33
| Professional | | $354.81 | $562.34 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $758.58
| Professional | | $407.38 | $549.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $512.86 / $1,047.13
| Professional | | $457.09 | $512.86 | $1,047.13 |