- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.63 / $506.87 / $689.29
| Professional | | $335.63 | $506.87 | $689.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.08 / $480.09 / $675.27
| Professional | | $408.08 | $480.09 | $675.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.23 / $677.29 / $1,033.73
| Professional | | $441.23 | $677.29 | $1,033.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.76 / $640.15 / $1,136.20
| Professional | | $437.76 | $640.15 | $1,136.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.63 / $459.87 / $689.29
| Professional | | $335.63 | $459.87 | $689.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.08 / $755.88 / $989.49
| Professional | | $497.08 | $755.88 | $989.49 |