- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $398.11 / $891.25
| Professional | | $309.03 | $398.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $512.86 / $741.31
| Professional | | $338.84 | $512.86 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $512.86 / $794.33
| Professional | | $389.05 | $512.86 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $562.34 / $1,071.52
| Professional | | $426.58 | $562.34 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $1,122.02
| Professional | | $338.84 | $478.63 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $812.83
| Professional | | $302.00 | $457.09 | $812.83 |