- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.43 / $286.64 / $340.52
| Professional | | $206.43 | $286.64 | $340.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.37 / $388.26 / $1,060.89
| Professional | | $329.37 | $388.26 | $1,060.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.43 / $435.27 / $628.95
| Professional | | $282.43 | $435.27 | $628.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.51 / $412.66 / $628.95
| Professional | | $331.51 | $412.66 | $628.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.93 / $395.04 / $1,148.40
| Professional | | $309.93 | $395.04 | $1,148.40 |