- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.29 / $590.85 / $842.08
| Professional | | $438.29 | $590.85 | $842.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.99 / $642.41 / $939.16
| Professional | | $533.99 | $642.41 | $939.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.84 / $921.78 / $1,347.02
| Professional | | $553.84 | $921.78 | $1,347.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.53 / $806.26 / $1,431.03
| Professional | | $612.53 | $806.26 | $1,431.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.29 / $590.85 / $842.08
| Professional | | $438.29 | $590.85 | $842.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.02 / $923.68 / $1,322.84
| Professional | | $637.02 | $923.68 | $1,322.84 |