- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.14 / $367.79 / $449.48
| Professional | | $311.14 | $367.79 | $449.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.35 / $310.35 / $310.35
| Professional | | $310.35 | $310.35 | $310.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.80 / $743.76 / $1,093.35
| Professional | | $363.80 | $743.76 | $1,093.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.35 / $364.08 / $455.83
| Professional | | $310.35 | $364.08 | $455.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.38 / $310.38 / $934.00
| Professional | | $310.38 | $310.38 | $934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.75 / $480.90 / $864.89
| Professional | | $335.75 | $480.90 | $864.89 |