- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.46 / $651.14 / $775.03
| Professional | | $514.46 | $651.14 | $775.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.71 / $838.22 / $1,196.03
| Professional | | $647.71 | $838.22 | $1,196.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.67 / $930.04 / $1,335.63
| Professional | | $640.67 | $930.04 | $1,335.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.12 / $903.76 / $1,386.41
| Professional | | $781.12 | $903.76 | $1,386.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.46 / $732.40 / $775.03
| Professional | | $514.46 | $732.40 | $775.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.69 / $806.79 / $1,059.60
| Professional | | $578.69 | $806.79 | $1,059.60 |