- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.65 / $734.98 / $877.75
| Professional | | $582.65 | $734.98 | $877.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.78 / $948.31 / $1,349.40
| Professional | | $732.78 | $948.31 | $1,349.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.70 / $1,053.30 / $1,509.49
| Professional | | $721.70 | $1,053.30 | $1,509.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.28 / $1,019.64 / $1,564.18
| Professional | | $881.28 | $1,019.64 | $1,564.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.65 / $799.32 / $877.75
| Professional | | $582.65 | $799.32 | $877.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.81 / $930.73 / $1,402.58
| Professional | | $664.81 | $930.73 | $1,402.58 |