- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.03 / $348.78 / $395.50
| Professional | | $251.03 | $348.78 | $395.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.08 / $456.08 / $1,229.79
| Professional | | $456.08 | $456.08 | $1,229.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.06 / $519.15 / $735.53
| Professional | | $338.06 | $519.15 | $735.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.52 / $485.53 / $735.53
| Professional | | $401.52 | $485.53 | $735.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.30 / $461.97 / $1,342.99
| Professional | | $377.30 | $461.97 | $1,342.99 |