- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.13 / $389.61 / $543.72
| Professional | | $278.13 | $389.61 | $543.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.41 / $526.01 / $776.22
| Professional | | $355.41 | $526.01 | $776.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.79 / $632.26 / $1,006.61
| Professional | | $358.79 | $632.26 | $1,006.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.63 / $636.14 / $1,060.40
| Professional | | $433.63 | $636.14 | $1,060.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.13 / $358.55 / $543.72
| Professional | | $278.13 | $358.55 | $543.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.85 / $682.36 / $1,020.41
| Professional | | $486.85 | $682.36 | $1,020.41 |