- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.11 / $330.14 / $460.28
| Professional | | $236.11 | $330.14 | $460.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.52 / $538.14 / $1,396.43
| Professional | | $456.52 | $538.14 | $1,396.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.16 / $506.54 / $903.15
| Professional | | $345.16 | $506.54 | $903.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.52 / $537.91 / $903.15
| Professional | | $365.52 | $537.91 | $903.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.63 / $565.74 / $1,649.04
| Professional | | $392.63 | $565.74 | $1,649.04 |