- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.12 / $432.68 / $527.54
| Professional | | $326.12 | $432.68 | $527.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.58 / $585.42 / $836.70
| Professional | | $441.58 | $585.42 | $836.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.42 / $665.97 / $1,073.48
| Professional | | $417.42 | $665.97 | $1,073.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.66 / $670.28 / $1,117.30
| Professional | | $515.66 | $670.28 | $1,117.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.12 / $432.68 / $807.14
| Professional | | $326.12 | $432.68 | $807.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.12 / $752.59 / $1,085.89
| Professional | | $515.12 | $752.59 | $1,085.89 |