- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.08 / $438.57 / $1,345.80
| Professional | | $256.08 | $438.57 | $1,345.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.98 / $981.53 / $1,587.88
| Professional | | $865.98 | $981.53 | $1,587.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.86 / $487.12 / $752.78
| Professional | | $354.86 | $487.12 | $752.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.86 / $487.12 / $752.78
| Professional | | $354.86 | $487.12 | $752.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.41 / $617.89 / $1,796.25
| Professional | | $520.41 | $617.89 | $1,796.25 |