- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $354.81 / $446.68
| Professional | | $288.40 | $354.81 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $416.87 / $691.83
| Professional | | $186.21 | $416.87 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $724.44
| Professional | | $416.87 | $501.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $549.54 / $794.33
| Professional | | $446.68 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $371.54 / $446.68
| Professional | | $309.03 | $371.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $588.84 / $812.83
| Professional | | $436.52 | $588.84 | $812.83 |