- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.43 / $296.68 / $561.03
| Professional | | $231.43 | $296.68 | $561.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.40 / $383.41 / $562.72
| Professional | | $255.40 | $383.41 | $562.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.26 / $522.53 / $854.18
| Professional | | $288.26 | $522.53 | $854.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.48 / $523.41 / $1,022.93
| Professional | | $259.48 | $523.41 | $1,022.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.96 / $585.95 / $1,332.69
| Professional | | $226.96 | $585.95 | $1,332.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.71 / $283.25 / $401.52
| Professional | | $189.71 | $283.25 | $401.52 |