- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.54 / $321.82 / $352.08
| Professional | | $308.54 | $321.82 | $352.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.53 / $478.02 / $1,081.53
| Professional | | $405.53 | $478.02 | $1,081.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.42 / $426.56 / $655.48
| Professional | | $291.42 | $426.56 | $655.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.77 / $426.56 / $655.48
| Professional | | $305.77 | $426.56 | $655.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.56 / $411.70 / $1,196.83
| Professional | | $341.56 | $411.70 | $1,196.83 |