- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $562.34 / $954.99
| Professional | | $269.15 | $562.34 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $537.03 / $977.24
| Professional | | $251.19 | $537.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,122.02
| Professional | | $331.13 | $575.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $660.69 / $1,148.15
| Professional | | $288.40 | $660.69 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $660.69 / $1,148.15
| Professional | | $275.42 | $660.69 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $616.60 / $1,230.27
| Professional | | $302.00 | $616.60 | $1,230.27 |