- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.36 / $374.10 / $405.42
| Professional | | $326.36 | $374.10 | $405.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.60 / $489.60 / $715.33
| Professional | | $407.60 | $489.60 | $715.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.03 / $561.15 / $807.05
| Professional | | $442.03 | $561.15 | $807.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.48 / $535.10 / $820.87
| Professional | | $415.48 | $535.10 | $820.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.36 / $374.10 / $412.37
| Professional | | $326.36 | $374.10 | $412.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.16 / $542.03 / $743.89
| Professional | | $403.16 | $542.03 | $743.89 |