- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.19 / $338.74 / $468.27
| Professional | | $220.19 | $338.74 | $468.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.28 / $640.41 / $1,371.72
| Professional | | $543.28 | $640.41 | $1,371.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.41 / $497.78 / $886.84
| Professional | | $318.41 | $497.78 | $886.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.82 / $537.76 / $886.84
| Professional | | $338.82 | $537.76 | $886.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.86 / $547.95 / $1,619.29
| Professional | | $426.86 | $547.95 | $1,619.29 |