- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $467.74 / $741.31
| Professional | | $245.47 | $467.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $676.08 / $1,380.38
| Professional | | $562.34 | $676.08 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $512.86 / $954.99
| Professional | | $223.87 | $512.86 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $794.33
| Professional | | $489.78 | $741.31 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $630.96 / $1,288.25
| Professional | | $371.54 | $630.96 | $1,288.25 |