- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.51 / $477.61 / $591.76
| Professional | | $281.51 | $477.61 | $591.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.29 / $462.75 / $494.34
| Professional | | $375.29 | $462.75 | $494.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.82 / $477.61 / $719.20
| Professional | | $367.82 | $477.61 | $719.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.93 / $411.79 / $640.75
| Professional | | $369.93 | $411.79 | $640.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.40 / $477.61 / $591.76
| Professional | | $216.40 | $477.61 | $591.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.94 / $377.19 / $505.43
| Professional | | $268.94 | $377.19 | $505.43 |