- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.61 / $583.45 / $778.65
| Professional | | $465.61 | $583.45 | $778.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.25 / $842.79 / $1,203.60
| Professional | | $651.25 | $842.79 | $1,203.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.07 / $935.41 / $1,343.13
| Professional | | $645.07 | $935.41 | $1,343.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.07 / $909.48 / $1,395.20
| Professional | | $786.07 | $909.48 | $1,395.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.24 / $583.45 / $1,013.98
| Professional | | $484.24 | $583.45 | $1,013.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.38 / $726.77 / $1,328.19
| Professional | | $519.38 | $726.77 | $1,328.19 |