- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.42 / $600.45 / $737.87
| Professional | | $477.42 | $600.45 | $737.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.10 / $623.95 / $912.87
| Professional | | $507.10 | $623.95 | $912.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.35 / $864.69 / $1,263.58
| Professional | | $585.35 | $864.69 | $1,263.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.63 / $731.08 / $1,295.69
| Professional | | $595.63 | $731.08 | $1,295.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.42 / $600.45 / $737.87
| Professional | | $477.42 | $600.45 | $737.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.79 / $802.47 / $1,206.01
| Professional | | $533.79 | $802.47 | $1,206.01 |