- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.28 / $400.28 / $485.66
| Professional | | $400.28 | $400.28 | $485.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.87 / $597.41 / $902.53
| Professional | | $476.87 | $597.41 | $902.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.84 / $654.05 / $914.93
| Professional | | $520.84 | $654.05 | $914.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.75 / $684.85 / $1,050.59
| Professional | | $531.75 | $684.85 | $1,050.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.28 / $400.28 / $485.66
| Professional | | $400.28 | $400.28 | $485.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.07 / $663.65 / $961.23
| Professional | | $498.07 | $663.65 | $961.23 |