- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.46 / $722.53 / $858.14
| Professional | | $525.46 | $722.53 | $858.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.29 / $715.49 / $1,039.61
| Professional | | $623.29 | $715.49 | $1,039.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.49 / $944.73 / $1,355.54
| Professional | | $671.49 | $944.73 | $1,355.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.02 / $818.33 / $1,431.03
| Professional | | $683.02 | $818.33 | $1,431.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.46 / $722.53 / $858.14
| Professional | | $525.46 | $722.53 | $858.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.54 / $1,031.26 / $1,358.16
| Professional | | $644.54 | $1,031.26 | $1,358.16 |