- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.19 / $302.32 / $559.25
| Professional | | $212.19 | $302.32 | $559.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.18 / $376.62 / $1,154.04
| Professional | | $310.18 | $376.62 | $1,154.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.88 / $321.29 / $855.19
| Professional | | $224.88 | $321.29 | $855.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.39 / $433.37 / $855.19
| Professional | | $292.39 | $433.37 | $855.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.20 / $390.62 / $1,233.38
| Professional | | $318.20 | $390.62 | $1,233.38 |