- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.18 / $442.79 / $489.97
| Professional | | $345.18 | $442.79 | $489.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.38 / $559.61 / $882.08
| Professional | | $435.38 | $559.61 | $882.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.29 / $633.58 / $921.23
| Professional | | $468.29 | $633.58 | $921.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.82 / $641.92 / $984.75
| Professional | | $554.82 | $641.92 | $984.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.18 / $489.97 / $558.49
| Professional | | $345.18 | $489.97 | $558.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.59 / $502.32 / $863.76
| Professional | | $369.59 | $502.32 | $863.76 |