- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.72 / $316.56 / $395.47
| Professional | | $271.72 | $316.56 | $395.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.34 / $477.63 / $562.79
| Professional | | $389.34 | $477.63 | $562.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.87 / $498.40 / $566.05
| Professional | | $456.87 | $498.40 | $566.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $413.39 / $520.07
| Professional | | $32.34 | $413.39 | $520.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.13 / $435.31 / $510.67
| Professional | | $361.13 | $435.31 | $510.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.35 / $418.95 / $581.41
| Professional | | $316.35 | $418.95 | $581.41 |