- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.11 / $548.70 / $680.16
| Professional | | $455.11 | $548.70 | $680.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.47 / $668.42 / $952.91
| Professional | | $523.47 | $668.42 | $952.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.23 / $785.63 / $1,126.63
| Professional | | $546.23 | $785.63 | $1,126.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.09 / $764.50 / $1,240.81
| Professional | | $638.09 | $764.50 | $1,240.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.11 / $596.88 / $841.46
| Professional | | $455.11 | $596.88 | $841.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.84 / $723.56 / $1,121.94
| Professional | | $515.84 | $723.56 | $1,121.94 |