- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.83 / $475.79 / $633.09
| Professional | | $354.83 | $475.79 | $633.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.42 / $528.60 / $736.98
| Professional | | $421.42 | $528.60 | $736.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.41 / $759.71 / $1,125.61
| Professional | | $465.41 | $759.71 | $1,125.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.18 / $681.37 / $1,209.35
| Professional | | $506.18 | $681.37 | $1,209.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.90 / $475.79 / $633.09
| Professional | | $381.90 | $475.79 | $633.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.42 / $695.68 / $1,107.52
| Professional | | $477.42 | $695.68 | $1,107.52 |