- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.56 / $281.05 / $432.68
| Professional | | $194.56 | $281.05 | $432.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.22 / $542.35 / $954.44
| Professional | | $342.22 | $542.35 | $954.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.72 / $699.34 / $1,209.98
| Professional | | $417.72 | $699.34 | $1,209.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.99 / $655.22 / $1,137.28
| Professional | | $408.99 | $655.22 | $1,137.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.36 / $563.90 / $1,507.28
| Professional | | $320.36 | $563.90 | $1,507.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.36 / $477.90 / $972.28
| Professional | | $320.36 | $477.90 | $972.28 |