- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.99 / $898.52 / $1,068.30
| Professional | | $717.99 | $898.52 | $1,068.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.52 / $1,173.52 / $1,842.96
| Professional | | $944.52 | $1,173.52 | $1,842.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.73 / $1,410.53 / $1,850.70
| Professional | | $928.73 | $1,410.53 | $1,850.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,203.61 / $1,392.59 / $2,136.31
| Professional | | $1,203.61 | $1,392.59 | $2,136.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.99 / $988.75 / $1,068.30
| Professional | | $717.99 | $988.75 | $1,068.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.44 / $1,200.46 / $1,872.83
| Professional | | $726.44 | $1,200.46 | $1,872.83 |