- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.62 / $322.89 / $606.73
| Professional | | $230.62 | $322.89 | $606.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.88 / $438.16 / $1,342.68
| Professional | | $360.88 | $438.16 | $1,342.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.09 / $348.94 / $908.37
| Professional | | $244.09 | $348.94 | $908.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.31 / $460.32 / $908.37
| Professional | | $317.31 | $460.32 | $908.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.41 / $450.58 / $1,309.85
| Professional | | $328.41 | $450.58 | $1,309.85 |