- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.02 / $403.68 / $484.82
| Professional | | $330.02 | $403.68 | $484.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.41 / $291.50 / $407.20
| Professional | | $246.41 | $291.50 | $407.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.03 / $497.76 / $689.21
| Professional | | $402.03 | $497.76 | $689.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.89 / $452.58 / $898.24
| Professional | | $295.89 | $452.58 | $898.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.00 / $527.19 / $826.52
| Professional | | $416.00 | $527.19 | $826.52 |