- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.06 / $359.63 / $453.14
| Professional | | $350.06 | $359.63 | $453.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.96 / $505.30 / $1,327.27
| Professional | | $471.96 | $505.30 | $1,327.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.77 / $561.72 / $1,201.33
| Professional | | $382.77 | $561.72 | $1,201.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.05 / $494.13 / $834.22
| Professional | | $383.05 | $494.13 | $834.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.74 / $444.64 / $746.77
| Professional | | $339.74 | $444.64 | $746.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.05 / $383.05 / $554.37
| Professional | | $383.05 | $383.05 | $554.37 |