- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.61 / $489.47 / $572.48
| Professional | | $392.61 | $489.47 | $572.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.74 / $487.49 / $609.36
| Professional | | $362.74 | $487.49 | $609.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.25 / $540.26 / $737.90
| Professional | | $391.25 | $540.26 | $737.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.30 / $427.30 / $427.30
| Professional | | $427.30 | $427.30 | $427.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.24 / $339.11 / $591.25
| Professional | | $32.24 | $339.11 | $591.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.91 / $521.46 / $1,386.36
| Professional | | $392.91 | $521.46 | $1,386.36 |