- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.39 / $504.32 / $592.96
| Professional | | $428.39 | $504.32 | $592.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.35 / $643.63 / $927.16
| Professional | | $497.35 | $643.63 | $927.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.73 / $711.56 / $1,029.42
| Professional | | $499.73 | $711.56 | $1,029.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.52 / $700.59 / $1,074.74
| Professional | | $605.52 | $700.59 | $1,074.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.39 / $497.51 / $796.18
| Professional | | $428.39 | $497.51 | $796.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.00 / $581.89 / $967.35
| Professional | | $405.00 | $581.89 | $967.35 |