- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.75 / $399.91 / $484.65
| Professional | | $366.75 | $399.91 | $484.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.81 / $472.94 / $668.98
| Professional | | $370.81 | $472.94 | $668.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.60 / $378.60 / $699.00
| Facility | | $378.60 | $378.60 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.62 / $504.00 / $707.33
| Professional | | $369.62 | $504.00 | $707.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.89 / $467.38 / $731.37
| Professional | | $362.89 | $467.38 | $731.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.85 / $399.91 / $768.48
| Professional | | $393.85 | $399.91 | $768.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.05 / $530.94 / $687.53
| Professional | | $336.05 | $530.94 | $687.53 |