- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.41 / $341.61 / $341.61
| Professional | | $339.41 | $341.61 | $341.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.63 / $463.31 / $688.94
| Professional | | $370.63 | $463.31 | $688.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.32 / $510.06 / $785.92
| Professional | | $401.32 | $510.06 | $785.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.33 / $511.73 / $785.02
| Professional | | $397.33 | $511.73 | $785.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.03 / $341.61 / $341.61
| Professional | | $333.03 | $341.61 | $341.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.50 / $484.35 / $723.51
| Professional | | $315.50 | $484.35 | $723.51 |