- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.08 / $551.37 / $649.03
| Professional | | $426.08 | $551.37 | $649.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.05 / $706.67 / $1,015.52
| Professional | | $546.05 | $706.67 | $1,015.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.03 / $778.84 / $1,127.97
| Professional | | $546.03 | $778.84 | $1,127.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.23 / $767.36 / $1,177.17
| Professional | | $663.23 | $767.36 | $1,177.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.08 / $506.30 / $649.03
| Professional | | $426.08 | $506.30 | $649.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.35 / $612.74 / $792.72
| Professional | | $441.35 | $612.74 | $792.72 |