- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.86 / $286.57 / $343.80
| Professional | | $226.86 | $286.57 | $343.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.50 / $378.60 / $378.60
| Professional | | $315.50 | $378.60 | $378.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.68 / $354.68 / $354.68
| Professional | | $354.68 | $354.68 | $354.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.55 / $449.82 / $598.26
| Professional | | $381.55 | $449.82 | $598.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.36 / $338.36 / $520.55
| Professional | | $253.36 | $338.36 | $520.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.77 / $416.77 / $416.80
| Professional | | $416.77 | $416.77 | $416.80 |