- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.87 / $501.06 / $849.40
| Professional | | $377.87 | $501.06 | $849.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.80 / $475.06 / $693.63
| Professional | | $403.80 | $475.06 | $693.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.56 / $782.92 / $1,311.57
| Professional | | $444.56 | $782.92 | $1,311.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.01 / $771.23 / $1,238.13
| Professional | | $453.01 | $771.23 | $1,238.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.87 / $501.06 / $849.40
| Professional | | $377.87 | $501.06 | $849.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.70 / $1,263.08 / $1,700.32
| Professional | | $633.70 | $1,263.08 | $1,700.32 |