- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.81 / $545.54 / $624.28
| Professional | | $438.81 | $545.54 | $624.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.35 / $621.75 / $839.52
| Professional | | $444.35 | $621.75 | $839.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.49 / $700.46 / $1,028.22
| Professional | | $449.49 | $700.46 | $1,028.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.55 / $660.70 / $1,101.33
| Professional | | $464.55 | $660.70 | $1,101.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.37 / $544.17 / $624.28
| Professional | | $424.37 | $544.17 | $624.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.72 / $703.87 / $1,081.63
| Professional | | $504.72 | $703.87 | $1,081.63 |