- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.01 / $527.15 / $740.05
| Professional | | $384.01 | $527.15 | $740.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.55 / $547.71 / $783.37
| Professional | | $465.55 | $547.71 | $783.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.00 / $794.42 / $1,135.80
| Professional | | $513.00 | $794.42 | $1,135.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.54 / $700.33 / $1,243.02
| Professional | | $511.54 | $700.33 | $1,243.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.01 / $527.15 / $740.05
| Professional | | $384.01 | $527.15 | $740.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.09 / $791.07 / $1,150.27
| Professional | | $497.09 | $791.07 | $1,150.27 |