- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.52 / $416.51 / $534.40
| Professional | | $354.52 | $416.51 | $534.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.05 / $528.05 / $738.83
| Professional | | $408.05 | $528.05 | $738.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.55 / $616.69 / $887.28
| Professional | | $425.55 | $616.69 | $887.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.01 / $615.84 / $1,006.71
| Professional | | $514.01 | $615.84 | $1,006.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.52 / $469.82 / $534.40
| Professional | | $354.52 | $469.82 | $534.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.99 / $552.67 / $911.56
| Professional | | $362.99 | $552.67 | $911.56 |