- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.46 / $305.92 / $350.26
| Professional | | $220.46 | $305.92 | $350.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.49 / $409.61 / $1,089.63
| Professional | | $347.49 | $409.61 | $1,089.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.38 / $455.51 / $658.34
| Professional | | $294.38 | $455.51 | $658.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.20 / $434.62 / $658.34
| Professional | | $352.20 | $434.62 | $658.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.02 / $413.49 / $707.60
| Professional | | $342.02 | $413.49 | $707.60 |