- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.56 / $486.42 / $486.42
| Professional | | $478.56 | $486.42 | $486.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.71 / $654.85 / $949.98
| Professional | | $522.71 | $654.85 | $949.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.99 / $729.63 / $1,079.69
| Professional | | $576.99 | $729.63 | $1,079.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.37 / $723.01 / $1,109.14
| Professional | | $561.37 | $723.01 | $1,109.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.56 / $486.42 / $486.42
| Professional | | $478.56 | $486.42 | $486.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.41 / $630.66 / $1,006.03
| Professional | | $565.41 | $630.66 | $1,006.03 |