- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.34 / $596.34 / $673.69
| Professional | | $596.34 | $596.34 | $673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.03 / $621.45 / $940.38
| Professional | | $556.03 | $621.45 | $940.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.24 / $689.09 / $987.24
| Professional | | $580.24 | $689.09 | $987.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.38 / $658.62 / $1,010.36
| Professional | | $511.38 | $658.62 | $1,010.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.34 / $596.34 / $673.69
| Professional | | $596.34 | $596.34 | $673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.76 / $663.98 / $909.11
| Professional | | $571.76 | $663.98 | $909.11 |