- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.12 / $444.09 / $803.45
| Professional | | $328.12 | $444.09 | $803.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.98 / $620.59 / $802.58
| Professional | | $453.98 | $620.59 | $802.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.37 / $311.81 / $517.25
| Professional | | $29.37 | $311.81 | $517.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.08 / $620.09 / $839.81
| Professional | | $456.08 | $620.09 | $839.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.66 / $554.40 / $854.17
| Professional | | $447.66 | $554.40 | $854.17 |