- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.06 / $341.06 / $385.24
| Professional | | $341.06 | $341.06 | $385.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.29 / $355.92 / $534.53
| Professional | | $316.29 | $355.92 | $534.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.60 / $393.40 / $563.62
| Professional | | $332.60 | $393.40 | $563.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.69 / $374.38 / $574.32
| Professional | | $290.69 | $374.38 | $574.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.08 / $341.06 / $385.24
| Professional | | $285.08 | $341.06 | $385.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.87 / $380.48 / $516.96
| Professional | | $286.87 | $380.48 | $516.96 |