- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.43 / $321.07 / $367.90
| Professional | | $231.43 | $321.07 | $367.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.14 / $418.63 / $1,147.89
| Professional | | $355.14 | $418.63 | $1,147.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.64 / $484.37 / $690.71
| Professional | | $311.64 | $484.37 | $690.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.23 / $455.61 / $690.71
| Professional | | $370.23 | $455.61 | $690.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.98 / $433.82 / $1,261.14
| Professional | | $353.98 | $433.82 | $1,261.14 |