- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.48 / $355.50 / $623.53
| Professional | | $280.48 | $355.50 | $623.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.99 / $455.52 / $637.29
| Professional | | $351.99 | $455.52 | $637.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.05 / $539.15 / $757.89
| Professional | | $375.05 | $539.15 | $757.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.70 / $522.01 / $839.90
| Professional | | $435.70 | $522.01 | $839.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.43 / $417.45 / $657.09
| Professional | | $300.43 | $417.45 | $657.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.71 / $474.19 / $762.59
| Professional | | $338.71 | $474.19 | $762.59 |