- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.51 / $704.41 / $841.86
| Professional | | $557.51 | $704.41 | $841.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.55 / $904.01 / $1,295.13
| Professional | | $698.55 | $904.01 | $1,295.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.14 / $1,038.98 / $1,444.13
| Professional | | $693.14 | $1,038.98 | $1,444.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.83 / $978.63 / $1,501.26
| Professional | | $845.83 | $978.63 | $1,501.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.51 / $809.80 / $841.86
| Professional | | $557.51 | $809.80 | $841.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.70 / $920.56 / $1,345.81
| Professional | | $575.70 | $920.56 | $1,345.81 |