- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.45 / $500.10 / $671.68
| Professional | | $370.45 | $500.10 | $671.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.60 / $459.74 / $631.55
| Professional | | $334.60 | $459.74 | $631.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.57 / $668.21 / $962.22
| Professional | | $534.57 | $668.21 | $962.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.26 / $551.94 / $983.57
| Professional | | $353.26 | $551.94 | $983.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.11 / $611.11 / $1,026.43
| Professional | | $467.11 | $611.11 | $1,026.43 |