- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.15 / $528.73 / $638.79
| Professional | | $461.15 | $528.73 | $638.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.24 / $664.53 / $969.67
| Professional | | $525.24 | $664.53 | $969.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.94 / $765.20 / $1,100.76
| Professional | | $527.94 | $765.20 | $1,100.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.38 / $743.51 / $1,140.58
| Professional | | $634.38 | $743.51 | $1,140.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.19 / $572.23 / $638.79
| Professional | | $424.19 | $572.23 | $638.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.48 / $683.51 / $1,031.66
| Professional | | $485.48 | $683.51 | $1,031.66 |