- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.50 / $291.17 / $396.35
| Professional | | $236.50 | $291.17 | $396.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.91 / $748.29 / $964.29
| Professional | | $397.91 | $748.29 | $964.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.77 / $702.18 / $1,110.75
| Professional | | $434.77 | $702.18 | $1,110.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.46 / $661.12 / $1,031.55
| Professional | | $430.46 | $661.12 | $1,031.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.48 / $528.47 / $2,021.28
| Professional | | $279.48 | $528.47 | $2,021.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.61 / $507.89 / $927.35
| Professional | | $280.61 | $507.89 | $927.35 |