- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.59 / $486.75 / $1,106.92
| Professional | | $253.59 | $486.75 | $1,106.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.47 / $495.20 / $590.32
| Professional | | $295.47 | $495.20 | $590.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.00 / $470.58 / $1,137.26
| Professional | | $282.00 | $470.58 | $1,137.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.25 / $596.38 / $979.53
| Professional | | $458.25 | $596.38 | $979.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.50 / $458.96 / $901.71
| Professional | | $237.50 | $458.96 | $901.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.11 / $531.66 / $658.56
| Professional | | $183.11 | $531.66 | $658.56 |