- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.93 / $424.21 / $1,644.99
| Professional | | $310.93 | $424.21 | $1,644.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.91 / $761.40 / $1,754.92
| Professional | | $645.91 | $761.40 | $1,754.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.10 / $517.11 / $830.47
| Professional | | $284.10 | $517.11 | $830.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.10 / $515.57 / $802.37
| Professional | | $284.10 | $515.57 | $802.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.79 / $646.53 / $1,960.02
| Professional | | $455.79 | $646.53 | $1,960.02 |