- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.40 / $469.53 / $469.53
| Professional | | $364.40 | $469.53 | $469.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.29 / $614.61 / $897.13
| Professional | | $474.29 | $614.61 | $897.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.59 / $754.36 / $1,164.91
| Professional | | $467.59 | $754.36 | $1,164.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.02 / $735.23 / $1,225.58
| Professional | | $575.02 | $735.23 | $1,225.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.40 / $469.53 / $677.71
| Professional | | $364.40 | $469.53 | $677.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.30 / $774.13 / $1,185.33
| Professional | | $560.30 | $774.13 | $1,185.33 |