- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.46 / $361.83 / $389.73
| Professional | | $239.46 | $361.83 | $389.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.26 / $522.90 / $762.51
| Professional | | $322.26 | $522.90 | $762.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.70 / $623.91 / $966.92
| Professional | | $386.70 | $623.91 | $966.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.69 / $618.71 / $1,041.66
| Professional | | $374.69 | $618.71 | $1,041.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.12 / $315.57 / $389.73
| Professional | | $224.12 | $315.57 | $389.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.23 / $640.94 / $1,016.51
| Professional | | $455.23 | $640.94 | $1,016.51 |