- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.22 / $434.94 / $746.38
| Professional | | $280.22 | $434.94 | $746.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.00 / $476.47 / $694.27
| Professional | | $405.00 | $476.47 | $694.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.15 / $701.52 / $1,142.03
| Professional | | $409.15 | $701.52 | $1,142.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.42 / $730.01 / $1,235.57
| Professional | | $453.42 | $730.01 | $1,235.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.22 / $434.94 / $746.38
| Professional | | $280.22 | $434.94 | $746.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.16 / $772.14 / $1,273.14
| Professional | | $482.16 | $772.14 | $1,273.14 |