- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.42 / $311.39 / $324.08
| Professional | | $269.42 | $311.39 | $324.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.12 / $433.93 / $1,009.52
| Professional | | $368.12 | $433.93 | $1,009.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.42 / $434.15 / $606.75
| Professional | | $285.42 | $434.15 | $606.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.21 / $400.63 / $606.75
| Professional | | $340.21 | $400.63 | $606.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.19 / $381.09 / $1,107.86
| Professional | | $311.19 | $381.09 | $1,107.86 |