- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.31 / $585.61 / $823.72
| Professional | | $353.31 | $585.61 | $823.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.36 / $389.47 / $659.46
| Professional | | $332.36 | $389.47 | $659.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.97 / $608.17 / $1,145.45
| Professional | | $309.97 | $608.17 | $1,145.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $369.79 / $832.03
| Professional | | $32.34 | $369.79 | $832.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.65 / $774.05 / $1,182.40
| Professional | | $403.65 | $774.05 | $1,182.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.11 / $837.50 / $1,284.19
| Professional | | $460.11 | $837.50 | $1,284.19 |