- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.30 / $247.64 / $1,136.29
| Professional | | $177.30 | $247.64 | $1,136.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.97 / $421.97 / $866.79
| Professional | | $357.97 | $421.97 | $866.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.49 / $360.05 / $424.58
| Professional | | $209.49 | $360.05 | $424.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.49 / $358.07 / $424.58
| Professional | | $209.49 | $358.07 | $424.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.93 / $342.40 / $995.38
| Professional | | $275.93 | $342.40 | $995.38 |