- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.16 / $313.86 / $553.88
| Professional | | $270.16 | $313.86 | $553.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.33 / $426.93 / $1,269.43
| Professional | | $356.33 | $426.93 | $1,269.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.17 / $434.92 / $1,488.94
| Professional | | $300.17 | $434.92 | $1,488.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.43 / $397.78 / $1,269.43
| Professional | | $311.43 | $397.78 | $1,269.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.58 / $402.23 / $1,169.32
| Professional | | $258.58 | $402.23 | $1,169.32 |