- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $1,071.52
| Professional | | $346.74 | $512.86 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $549.54 / $794.33
| Professional | | $346.74 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,071.52
| Professional | | $446.68 | $645.65 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $676.08 / $1,230.27
| Professional | | $436.52 | $676.08 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $616.60 / $1,445.44
| Professional | | $380.19 | $616.60 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $549.54 / $1,047.13
| Professional | | $363.08 | $549.54 | $1,047.13 |