- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.27 / $443.55 / $1,733.04
| Professional | | $330.27 | $443.55 | $1,733.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.48 / $865.78 / $1,789.94
| Professional | | $734.48 | $865.78 | $1,789.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.59 / $547.04 / $849.43
| Professional | | $387.59 | $547.04 | $849.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.59 / $544.54 / $819.24
| Professional | | $387.59 | $544.54 | $819.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.19 / $586.32 / $1,997.79
| Professional | | $466.19 | $586.32 | $1,997.79 |