- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $426.58 / $912.01
| Professional | | $338.84 | $426.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $549.54 / $812.83
| Professional | | $363.08 | $549.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $851.14
| Professional | | $389.05 | $562.34 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $588.84 / $1,148.15
| Professional | | $446.68 | $588.84 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $1,230.27
| Professional | | $363.08 | $512.86 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $870.96
| Professional | | $316.23 | $489.78 | $870.96 |