- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.15 / $660.19 / $784.52
| Professional | | $521.15 | $660.19 | $784.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.55 / $849.66 / $1,213.07
| Professional | | $656.55 | $849.66 | $1,213.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.07 / $942.69 / $1,353.88
| Professional | | $650.07 | $942.69 | $1,353.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $792.25 / $916.63 / $1,406.16
| Professional | | $792.25 | $916.63 | $1,406.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.15 / $707.98 / $784.52
| Professional | | $521.15 | $707.98 | $784.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.04 / $852.67 / $1,261.21
| Professional | | $588.04 | $852.67 | $1,261.21 |