- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.20 / $281.74 / $670.51
| Professional | | $275.20 | $281.74 | $670.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.99 / $380.02 / $1,042.33
| Professional | | $312.99 | $380.02 | $1,042.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.29 / $374.71 / $1,042.33
| Professional | | $275.29 | $374.71 | $1,042.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.98 / $412.18 / $1,042.33
| Professional | | $275.98 | $412.18 | $1,042.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.75 / $384.57 / $1,279.34
| Professional | | $274.75 | $384.57 | $1,279.34 |