- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.68 / $406.65 / $702.75
| Professional | | $386.68 | $406.65 | $702.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.35 / $542.33 / $866.13
| Professional | | $470.35 | $542.33 | $866.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.48 / $615.41 / $881.68
| Professional | | $487.48 | $615.41 | $881.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.17 / $591.38 / $907.20
| Professional | | $459.17 | $591.38 | $907.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.68 / $406.65 / $702.75
| Professional | | $386.68 | $406.65 | $702.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.60 / $630.94 / $821.65
| Professional | | $493.60 | $630.94 | $821.65 |