- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.27 / $329.38 / $683.64
| Professional | | $265.27 | $329.38 | $683.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.41 / $273.43 / $582.14
| Professional | | $232.41 | $273.43 | $582.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.32 / $361.58 / $542.37
| Professional | | $301.32 | $361.58 | $542.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.22 / $633.61 / $1,072.32
| Professional | | $330.22 | $633.61 | $1,072.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.18 / $498.15 / $892.06
| Professional | | $303.18 | $498.15 | $892.06 |