- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.28 / $601.63 / $774.76
| Professional | | $559.28 | $601.63 | $774.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.42 / $839.14 / $1,201.08
| Professional | | $648.42 | $839.14 | $1,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.26 / $933.77 / $1,337.87
| Professional | | $644.26 | $933.77 | $1,337.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.42 / $907.57 / $1,392.27
| Professional | | $784.42 | $907.57 | $1,392.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.45 / $601.63 / $774.76
| Professional | | $512.45 | $601.63 | $774.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.82 / $847.08 / $1,095.35
| Professional | | $588.82 | $847.08 | $1,095.35 |