- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.66 / $671.44 / $800.44
| Professional | | $531.66 | $671.44 | $800.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.90 / $865.64 / $1,233.27
| Professional | | $668.90 | $865.64 | $1,233.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.92 / $960.52 / $1,378.41
| Professional | | $659.92 | $960.52 | $1,378.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.44 / $931.89 / $1,429.58
| Professional | | $805.44 | $931.89 | $1,429.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.66 / $729.27 / $800.44
| Professional | | $531.66 | $729.27 | $800.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.45 / $877.74 / $1,253.26
| Professional | | $613.45 | $877.74 | $1,253.26 |