- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.35 / $468.32 / $631.55
| Professional | | $413.35 | $468.32 | $631.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.70 / $609.70 / $871.62
| Professional | | $479.70 | $609.70 | $871.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.38 / $718.30 / $1,049.66
| Professional | | $521.38 | $718.30 | $1,049.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.03 / $697.33 / $1,155.21
| Professional | | $582.03 | $697.33 | $1,155.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.36 / $457.38 / $631.55
| Professional | | $380.36 | $457.38 | $631.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.19 / $662.56 / $1,047.21
| Professional | | $430.19 | $662.56 | $1,047.21 |