- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.92 / $305.93 / $526.40
| Professional | | $257.92 | $305.93 | $526.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.14 / $420.57 / $594.91
| Professional | | $326.14 | $420.57 | $594.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.91 / $497.46 / $697.08
| Professional | | $355.91 | $497.46 | $697.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.48 / $481.01 / $772.58
| Professional | | $401.48 | $481.01 | $772.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.92 / $327.02 / $542.29
| Professional | | $257.92 | $327.02 | $542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.79 / $458.69 / $677.30
| Professional | | $287.79 | $458.69 | $677.30 |