- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.75 / $438.17 / $479.07
| Professional | | $379.75 | $438.17 | $479.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.80 / $584.23 / $666.02
| Professional | | $525.80 | $584.23 | $666.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.50 / $361.01 / $1,435.77
| Professional | | $302.50 | $361.01 | $1,435.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.23 / $701.08 / $876.35
| Professional | | $584.23 | $701.08 | $876.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.38 / $292.12 / $473.16
| Professional | | $245.38 | $292.12 | $473.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.12 / $464.46 / $464.46
| Professional | | $292.12 | $464.46 | $464.46 |