- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.24 / $356.24 / $402.72
| Professional | | $356.24 | $356.24 | $402.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.67 / $370.65 / $561.09
| Professional | | $331.67 | $370.65 | $561.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.19 / $411.21 / $589.14
| Professional | | $346.19 | $411.21 | $589.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.13 / $392.98 / $602.84
| Professional | | $305.13 | $392.98 | $602.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.02 / $356.24 / $402.72
| Professional | | $302.02 | $356.24 | $402.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.69 / $413.54 / $608.30
| Professional | | $318.69 | $413.54 | $608.30 |