- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.41 / $616.16 / $932.75
| Professional | | $287.41 | $616.16 | $932.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.82 / $573.77 / $1,411.28
| Professional | | $234.82 | $573.77 | $1,411.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.32 / $402.83 / $931.14
| Professional | | $385.32 | $402.83 | $931.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.86 / $382.60 / $1,087.24
| Professional | | $234.86 | $382.60 | $1,087.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.88 / $571.74 / $991.98
| Professional | | $272.88 | $571.74 | $991.98 |