- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $389.05
| Professional | | $151.36 | $239.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $489.78 / $870.96
| Professional | | $295.12 | $489.78 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $616.60 / $1,096.48
| Professional | | $346.74 | $616.60 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $575.44 / $1,047.13
| Professional | | $363.08 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $512.86 / $1,445.44
| Professional | | $251.19 | $512.86 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $380.19 / $776.25
| Professional | | $194.98 | $380.19 | $776.25 |