- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.21 / $261.05 / $318.72
| Professional | | $169.21 | $261.05 | $318.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.34 / $569.72 / $874.54
| Professional | | $331.34 | $569.72 | $874.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.77 / $673.62 / $2,222.08
| Professional | | $320.77 | $673.62 | $2,222.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.98 / $529.64 / $817.87
| Professional | | $373.98 | $529.64 | $817.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.49 / $395.59 / $577.48
| Professional | | $286.49 | $395.59 | $577.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.85 / $571.79 / $889.45
| Professional | | $352.85 | $571.79 | $889.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.20 / $466.40 / $705.90
| Professional | | $381.20 | $466.40 | $705.90 |