- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.16 / $341.24 / $370.58
| Professional | | $305.16 | $341.24 | $370.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.97 / $416.07 / $1,151.08
| Professional | | $352.97 | $416.07 | $1,151.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.92 / $484.39 / $693.58
| Professional | | $311.92 | $484.39 | $693.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.22 / $457.58 / $693.58
| Professional | | $373.22 | $457.58 | $693.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.49 / $435.62 / $1,266.39
| Professional | | $352.49 | $435.62 | $1,266.39 |