- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.34 / $664.33 / $854.64
| Professional | | $456.34 | $664.33 | $854.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.97 / $661.52 / $973.49
| Professional | | $579.97 | $661.52 | $973.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.91 / $950.72 / $1,389.31
| Professional | | $631.91 | $950.72 | $1,389.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.49 / $818.22 / $1,452.26
| Professional | | $631.49 | $818.22 | $1,452.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.12 / $654.04 / $854.64
| Professional | | $522.12 | $654.04 | $854.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.15 / $881.85 / $1,343.18
| Professional | | $581.15 | $881.85 | $1,343.18 |