- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.35 / $636.32 / $849.78
| Professional | | $546.35 | $636.32 | $849.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.35 / $729.04 / $1,027.55
| Professional | | $563.35 | $729.04 | $1,027.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.16 / $825.93 / $1,177.33
| Professional | | $550.16 | $825.93 | $1,177.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.88 / $769.27 / $1,180.09
| Professional | | $664.88 | $769.27 | $1,180.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.02 / $709.77 / $849.78
| Professional | | $588.02 | $709.77 | $849.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.78 / $762.33 / $1,085.28
| Professional | | $536.78 | $762.33 | $1,085.28 |