- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.62 / $471.66 / $681.85
| Professional | | $329.62 | $471.66 | $681.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.40 / $491.06 / $701.97
| Professional | | $417.40 | $491.06 | $701.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.52 / $697.00 / $1,019.40
| Professional | | $458.52 | $697.00 | $1,019.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.54 / $640.97 / $1,137.66
| Professional | | $457.54 | $640.97 | $1,137.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.62 / $471.66 / $681.85
| Professional | | $329.62 | $471.66 | $681.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.40 / $721.24 / $1,055.34
| Professional | | $458.40 | $721.24 | $1,055.34 |