- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $446.68 / $891.25
| Professional | | $346.74 | $446.68 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $416.87 / $660.69
| Professional | | $338.84 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $676.08
| Professional | | $331.13 | $457.09 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $933.25
| Professional | | $331.13 | $562.34 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $758.58 / $3,162.28
| Professional | | $467.74 | $758.58 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $851.14
| Professional | | $371.54 | $524.81 | $851.14 |