- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.58 / $489.58 / $513.38
| Professional | | $489.58 | $489.58 | $513.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.92 / $643.38 / $946.16
| Professional | | $534.92 | $643.38 | $946.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.41 / $708.55 / $1,073.13
| Professional | | $528.41 | $708.55 | $1,073.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.75 / $710.61 / $1,090.10
| Professional | | $551.75 | $710.61 | $1,090.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.58 / $489.58 / $513.38
| Professional | | $489.58 | $489.58 | $513.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.88 / $672.38 / $993.62
| Professional | | $471.88 | $672.38 | $993.62 |