- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.73 / $388.65 / $543.66
| Professional | | $290.73 | $388.65 | $543.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.36 / $485.87 / $746.17
| Professional | | $326.36 | $485.87 | $746.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.73 / $510.73 / $699.00
| Facility | | $510.73 | $510.73 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.45 / $571.40 / $960.04
| Professional | | $327.45 | $571.40 | $960.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.99 / $585.74 / $1,039.63
| Professional | | $384.99 | $585.74 | $1,039.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.64 / $411.24 / $745.60
| Professional | | $291.64 | $411.24 | $745.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.10 / $542.90 / $982.94
| Professional | | $380.10 | $542.90 | $982.94 |