- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.75 / $332.46 / $367.36
| Professional | | $237.75 | $332.46 | $367.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.01 / $412.58 / $1,124.57
| Professional | | $350.01 | $412.58 | $1,124.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.20 / $485.91 / $678.22
| Professional | | $325.20 | $485.91 | $678.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.25 / $449.91 / $678.22
| Professional | | $369.25 | $449.91 | $678.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.22 / $419.04 / $1,238.34
| Professional | | $336.22 | $419.04 | $1,238.34 |