- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.25 / $318.39 / $770.52
| Professional | | $307.25 | $318.39 | $770.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.33 / $401.05 / $501.31
| Professional | | $391.33 | $401.05 | $501.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.72 / $409.56 / $809.09
| Professional | | $284.72 | $409.56 | $809.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.01 / $744.27 / $878.91
| Professional | | $355.01 | $744.27 | $878.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.83 / $401.45 / $1,038.59
| Professional | | $266.83 | $401.45 | $1,038.59 |