- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $371.54 / $912.01
| Professional | | $295.12 | $371.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $478.63 / $707.95
| Professional | | $331.13 | $478.63 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $489.78 / $758.58
| Professional | | $354.81 | $489.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $1,071.52
| Professional | | $416.87 | $549.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $436.52 / $1,023.29
| Professional | | $309.03 | $436.52 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $794.33
| Professional | | $281.84 | $426.58 | $794.33 |