- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $912.01
| Professional | | $331.13 | $416.87 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $537.03 / $794.33
| Professional | | $354.81 | $537.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $851.14
| Professional | | $389.05 | $549.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $575.44 / $1,148.15
| Professional | | $446.68 | $575.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $501.19 / $1,071.52
| Professional | | $331.13 | $501.19 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $478.63 / $851.14
| Professional | | $316.23 | $478.63 | $851.14 |