- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.94 / $742.39 / $742.39
| Professional | | $535.94 | $742.39 | $742.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.23 / $631.72 / $935.75
| Professional | | $501.23 | $631.72 | $935.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.65 / $742.39 / $1,041.45
| Professional | | $613.65 | $742.39 | $1,041.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.75 / $603.04 / $938.35
| Professional | | $541.75 | $603.04 | $938.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.94 / $742.39 / $742.39
| Professional | | $535.94 | $742.39 | $742.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.76 / $709.89 / $938.35
| Professional | | $510.76 | $709.89 | $938.35 |