- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.14 / $732.66 / $993.69
| Professional | | $593.14 | $732.66 | $993.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.27 / $810.91 / $1,200.50
| Professional | | $680.27 | $810.91 | $1,200.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.85 / $1,164.32 / $1,701.45
| Professional | | $796.85 | $1,164.32 | $1,701.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.11 / $952.59 / $1,690.75
| Professional | | $774.11 | $952.59 | $1,690.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.14 / $732.66 / $993.69
| Professional | | $593.14 | $732.66 | $993.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.72 / $1,041.63 / $1,580.35
| Professional | | $675.72 | $1,041.63 | $1,580.35 |