- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.63 / $620.79 / $620.79
| Professional | | $441.63 | $620.79 | $620.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.93 / $526.36 / $786.59
| Professional | | $429.93 | $526.36 | $786.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.80 / $620.79 / $866.41
| Professional | | $511.80 | $620.79 | $866.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.40 / $502.47 / $781.84
| Professional | | $451.40 | $502.47 | $781.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.63 / $620.79 / $620.79
| Professional | | $441.63 | $620.79 | $620.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.52 / $609.39 / $782.65
| Professional | | $456.52 | $609.39 | $782.65 |