- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.06 / $638.39 / $804.27
| Professional | | $471.06 | $638.39 | $804.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.79 / $688.38 / $985.58
| Professional | | $625.79 | $688.38 | $985.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.36 / $865.44 / $1,416.65
| Professional | | $650.36 | $865.44 | $1,416.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.38 / $799.67 / $1,244.29
| Professional | | $641.38 | $799.67 | $1,244.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.06 / $638.39 / $804.27
| Professional | | $471.06 | $638.39 | $804.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.08 / $985.77 / $1,306.31
| Professional | | $701.08 | $985.77 | $1,306.31 |