- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.56 / $345.60 / $552.62
| Professional | | $213.56 | $345.60 | $552.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.90 / $556.02 / $1,055.38
| Professional | | $349.90 | $556.02 | $1,055.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.82 / $693.03 / $1,332.27
| Professional | | $380.82 | $693.03 | $1,332.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.87 / $673.20 / $1,252.23
| Professional | | $386.87 | $673.20 | $1,252.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.17 / $562.57 / $1,491.84
| Professional | | $328.17 | $562.57 | $1,491.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.79 / $533.28 / $1,140.77
| Professional | | $343.79 | $533.28 | $1,140.77 |