- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.31 / $635.30 / $754.28
| Professional | | $495.31 | $635.30 | $754.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.83 / $817.67 / $1,166.35
| Professional | | $631.83 | $817.67 | $1,166.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.07 / $906.44 / $1,302.83
| Professional | | $625.07 | $906.44 | $1,302.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.75 / $881.34 / $1,352.03
| Professional | | $761.75 | $881.34 | $1,352.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.31 / $680.83 / $754.28
| Professional | | $495.31 | $680.83 | $754.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.89 / $789.28 / $1,213.00
| Professional | | $516.89 | $789.28 | $1,213.00 |