- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.55 / $514.78 / $574.03
| Professional | | $475.55 | $514.78 | $574.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.33 / $462.07 / $586.83
| Professional | | $450.33 | $462.07 | $586.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.73 / $532.54 / $1,064.27
| Professional | | $394.73 | $532.54 | $1,064.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.87 / $555.82 / $915.39
| Professional | | $430.87 | $555.82 | $915.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.45 / $484.38 / $812.82
| Professional | | $377.45 | $484.38 | $812.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.72 / $343.72 / $605.25
| Professional | | $343.72 | $343.72 | $605.25 |