- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.36 / $365.23 / $401.98
| Professional | | $261.36 | $365.23 | $401.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.85 / $569.17 / $1,141.35
| Professional | | $482.85 | $569.17 | $1,141.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.54 / $499.19 / $720.62
| Professional | | $331.54 | $499.19 | $720.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.40 / $499.19 / $720.62
| Professional | | $372.40 | $499.19 | $720.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.87 / $452.61 / $1,315.76
| Professional | | $392.87 | $452.61 | $1,315.76 |