- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.28 / $309.08 / $444.42
| Professional | | $222.28 | $309.08 | $444.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.72 / $455.57 / $1,365.89
| Professional | | $375.72 | $455.57 | $1,365.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.75 / $479.70 / $819.85
| Professional | | $339.75 | $479.70 | $819.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.62 / $480.25 / $819.85
| Professional | | $357.62 | $480.25 | $819.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.07 / $474.27 / $1,496.95
| Professional | | $430.07 | $474.27 | $1,496.95 |