- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.19 / $344.01 / $508.36
| Professional | | $256.19 | $344.01 | $508.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.11 / $495.80 / $1,035.13
| Professional | | $281.11 | $495.80 | $1,035.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.79 / $530.19 / $612.10
| Professional | | $347.79 | $530.19 | $612.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.23 / $424.05 / $823.22
| Professional | | $251.23 | $424.05 | $823.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.76 / $501.94 / $1,181.46
| Professional | | $304.76 | $501.94 | $1,181.46 |