- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.25 / $648.66 / $798.23
| Professional | | $510.25 | $648.66 | $798.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.36 / $822.23 / $1,173.79
| Professional | | $635.36 | $822.23 | $1,173.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.45 / $939.85 / $1,326.11
| Professional | | $622.45 | $939.85 | $1,326.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.16 / $881.82 / $1,352.76
| Professional | | $762.16 | $881.82 | $1,352.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.25 / $736.10 / $798.23
| Professional | | $510.25 | $736.10 | $798.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.51 / $843.27 / $1,231.33
| Professional | | $593.51 | $843.27 | $1,231.33 |