- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.92 / $552.64 / $614.37
| Professional | | $424.92 | $552.64 | $614.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.34 / $655.27 / $983.96
| Professional | | $506.34 | $655.27 | $983.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.98 / $737.24 / $1,124.22
| Professional | | $531.98 | $737.24 | $1,124.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.62 / $743.51 / $1,140.58
| Professional | | $642.62 | $743.51 | $1,140.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.92 / $513.96 / $854.49
| Professional | | $424.92 | $513.96 | $854.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.65 / $627.80 / $1,031.66
| Professional | | $453.65 | $627.80 | $1,031.66 |