- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.44 / $316.89 / $957.81
| Professional | | $197.44 | $316.89 | $957.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.62 / $491.73 / $817.25
| Professional | | $283.62 | $491.73 | $817.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.32 / $523.29 / $740.39
| Professional | | $377.32 | $523.29 | $740.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.97 / $480.35 / $727.00
| Professional | | $329.97 | $480.35 | $727.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.60 / $563.14 / $801.64
| Professional | | $377.60 | $563.14 | $801.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.97 / $560.29 / $832.75
| Professional | | $381.97 | $560.29 | $832.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.00 / $663.03 / $950.83
| Professional | | $448.00 | $663.03 | $950.83 |