- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.79 / $690.97 / $868.18
| Professional | | $566.79 | $690.97 | $868.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.27 / $714.43 / $1,011.01
| Professional | | $607.27 | $714.43 | $1,011.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.78 / $950.40 / $1,319.09
| Professional | | $652.78 | $950.40 | $1,319.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.53 / $801.00 / $1,407.62
| Professional | | $666.53 | $801.00 | $1,407.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.94 / $731.67 / $868.18
| Professional | | $575.94 | $731.67 | $868.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.06 / $1,051.53 / $1,363.09
| Professional | | $658.06 | $1,051.53 | $1,363.09 |