- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.40 / $711.17 / $847.53
| Professional | | $562.40 | $711.17 | $847.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.08 / $916.34 / $1,305.84
| Professional | | $708.08 | $916.34 | $1,305.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.10 / $1,017.04 / $1,459.46
| Professional | | $699.10 | $1,017.04 | $1,459.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.84 / $986.74 / $1,513.71
| Professional | | $852.84 | $986.74 | $1,513.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.40 / $749.01 / $847.53
| Professional | | $562.40 | $749.01 | $847.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.33 / $795.47 / $1,357.97
| Professional | | $576.33 | $795.47 | $1,357.97 |