- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.40 / $279.79 / $607.28
| Professional | | $188.40 | $279.79 | $607.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.20 / $400.58 / $844.30
| Professional | | $261.20 | $400.58 | $844.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.02 / $458.25 / $1,170.63
| Professional | | $256.02 | $458.25 | $1,170.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.92 / $685.08 / $1,099.83
| Professional | | $260.92 | $685.08 | $1,099.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.31 / $279.79 / $729.55
| Professional | | $230.31 | $279.79 | $729.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.30 / $612.28 / $1,162.74
| Professional | | $392.30 | $612.28 | $1,162.74 |