- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.48 / $410.36 / $658.07
| Professional | | $288.48 | $410.36 | $658.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.24 / $442.64 / $619.50
| Professional | | $376.24 | $442.64 | $619.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.77 / $645.89 / $989.12
| Professional | | $376.77 | $645.89 | $989.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.97 / $633.96 / $1,125.22
| Professional | | $417.97 | $633.96 | $1,125.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.48 / $410.36 / $658.07
| Professional | | $288.48 | $410.36 | $658.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.11 / $612.29 / $791.76
| Professional | | $425.11 | $612.29 | $791.76 |