- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.82 / $432.87 / $472.93
| Professional | | $401.82 | $432.87 | $472.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.02 / $592.94 / $1,467.81
| Professional | | $503.02 | $592.94 | $1,467.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.99 / $616.51 / $880.50
| Professional | | $397.99 | $616.51 | $880.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.10 / $532.85 / $880.50
| Professional | | $418.10 | $532.85 | $880.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.50 / $544.02 / $1,607.69
| Professional | | $415.50 | $544.02 | $1,607.69 |