- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $1,258.93
| Professional | | $323.59 | $407.38 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $588.84
| Professional | | $501.19 | $501.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $489.78 / $812.83
| Professional | | $263.03 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $512.86 / $616.60
| Professional | | $371.54 | $512.86 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $501.19 / $1,479.11
| Professional | | $407.38 | $501.19 | $1,479.11 |