- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.08 / $418.62 / $583.30
| Professional | | $367.08 | $418.62 | $583.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.99 / $575.16 / $792.05
| Professional | | $448.99 | $575.16 | $792.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.09 / $677.46 / $973.62
| Professional | | $460.09 | $677.46 | $973.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.04 / $657.82 / $1,074.01
| Professional | | $549.04 | $657.82 | $1,074.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.51 / $418.62 / $583.30
| Professional | | $354.51 | $418.62 | $583.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.59 / $587.13 / $972.24
| Professional | | $396.59 | $587.13 | $972.24 |