- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.05 / $354.47 / $533.62
| Professional | | $318.05 | $354.47 | $533.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.22 / $411.74 / $582.82
| Professional | | $328.22 | $411.74 | $582.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.38 / $310.38 / $310.38
| Professional | | $310.38 | $310.38 | $310.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.70 / $478.51 / $490.78
| Professional | | $342.70 | $478.51 | $490.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.94 / $631.91 / $838.46
| Professional | | $429.94 | $631.91 | $838.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.43 / $478.07 / $1,293.45
| Professional | | $353.43 | $478.07 | $1,293.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.61 / $536.05 / $921.08
| Professional | | $331.61 | $536.05 | $921.08 |