- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.18 / $395.10 / $548.54
| Professional | | $263.18 | $395.10 | $548.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.83 / $372.75 / $537.92
| Professional | | $316.83 | $372.75 | $537.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.93 / $547.25 / $808.60
| Professional | | $354.93 | $547.25 | $808.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.61 / $516.07 / $915.97
| Professional | | $351.61 | $516.07 | $915.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.18 / $395.10 / $548.54
| Professional | | $263.18 | $395.10 | $548.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.87 / $621.17 / $852.48
| Professional | | $413.87 | $621.17 | $852.48 |