- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.37 / $397.86 / $1,247.13
| Professional | | $290.37 | $397.86 | $1,247.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.22 / $559.27 / $784.15
| Professional | | $370.22 | $559.27 | $784.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.46 / $902.39 / $1,288.45
| Professional | | $489.46 | $902.39 | $1,288.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.95 / $810.64 / $1,456.09
| Professional | | $437.95 | $810.64 | $1,456.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.93 / $804.66 / $1,622.59
| Professional | | $487.93 | $804.66 | $1,622.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.83 / $382.47 / $458.96
| Professional | | $297.83 | $382.47 | $458.96 |