- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.65 / $314.01 / $567.41
| Professional | | $215.65 | $314.01 | $567.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.61 / $387.34 / $1,150.16
| Professional | | $316.61 | $387.34 | $1,150.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.40 / $336.24 / $897.90
| Professional | | $228.40 | $336.24 | $897.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.01 / $454.74 / $897.90
| Professional | | $296.01 | $454.74 | $897.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.52 / $403.78 / $1,292.76
| Professional | | $333.52 | $403.78 | $1,292.76 |