- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.64 / $322.27 / $425.72
| Professional | | $228.64 | $322.27 | $425.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.38 / $290.36 / $414.14
| Professional | | $192.38 | $290.36 | $414.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.20 / $355.97 / $465.32
| Professional | | $310.20 | $355.97 | $465.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.10 / $354.79 / $604.47
| Professional | | $249.10 | $354.79 | $604.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.85 / $374.28 / $675.06
| Professional | | $293.85 | $374.28 | $675.06 |