- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.25 / $376.45 / $492.38
| Professional | | $310.25 | $376.45 | $492.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.45 / $478.28 / $694.08
| Professional | | $411.45 | $478.28 | $694.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.80 / $625.78 / $869.04
| Professional | | $441.80 | $625.78 | $869.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.32 / $628.19 / $1,035.23
| Professional | | $524.32 | $628.19 | $1,035.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.25 / $376.61 / $492.38
| Professional | | $310.25 | $376.61 | $492.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.21 / $529.59 / $907.55
| Professional | | $374.21 | $529.59 | $907.55 |