- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $467.74 / $1,122.02
| Professional | | $380.19 | $467.74 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $602.56 / $912.01
| Professional | | $371.54 | $602.56 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $575.44 / $912.01
| Professional | | $467.74 | $575.44 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $562.34 / $1,047.13
| Professional | | $457.09 | $562.34 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $562.34 / $1,202.26
| Professional | | $407.38 | $562.34 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $537.03 / $870.96
| Professional | | $354.81 | $537.03 | $870.96 |