- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.16 / $725.21 / $796.70
| Professional | | $534.16 | $725.21 | $796.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.98 / $384.98 / $489.88
| Professional | | $384.98 | $384.98 | $489.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.95 / $714.00 / $1,100.28
| Professional | | $274.95 | $714.00 | $1,100.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.00 / $654.00 / $833.09
| Professional | | $459.00 | $654.00 | $833.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.75 / $590.40 / $833.09
| Professional | | $227.75 | $590.40 | $833.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.60 / $587.85 / $794.88
| Professional | | $345.60 | $587.85 | $794.88 |