- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.14 / $528.46 / $633.57
| Professional | | $424.14 | $528.46 | $633.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.12 / $692.51 / $972.61
| Professional | | $535.12 | $692.51 | $972.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.70 / $760.29 / $1,093.03
| Professional | | $516.70 | $760.29 | $1,093.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.20 / $734.93 / $1,127.42
| Professional | | $635.20 | $734.93 | $1,127.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.14 / $590.50 / $633.57
| Professional | | $424.14 | $590.50 | $633.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.06 / $733.59 / $988.37
| Professional | | $489.06 | $733.59 | $988.37 |