- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.55 / $612.50 / $729.49
| Professional | | $483.55 | $612.50 | $729.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.17 / $787.06 / $1,129.13
| Professional | | $608.17 | $787.06 | $1,129.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.74 / $877.94 / $1,255.07
| Professional | | $605.74 | $877.94 | $1,255.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.43 / $853.21 / $1,308.85
| Professional | | $737.43 | $853.21 | $1,308.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.55 / $655.40 / $729.49
| Professional | | $483.55 | $655.40 | $729.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.83 / $798.70 / $1,174.02
| Professional | | $550.83 | $798.70 | $1,174.02 |