- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.04 / $521.71 / $979.25
| Professional | | $340.04 | $521.71 | $979.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.60 / $530.48 / $975.62
| Professional | | $369.60 | $530.48 | $975.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.61 / $651.02 / $1,123.27
| Professional | | $418.61 | $651.02 | $1,123.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.40 / $642.25 / $1,292.65
| Professional | | $440.40 | $642.25 | $1,292.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.96 / $654.96 / $930.65
| Professional | | $654.96 | $654.96 | $930.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.63 / $681.93 / $1,184.24
| Professional | | $458.63 | $681.93 | $1,184.24 |