- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.82 / $642.33 / $762.85
| Professional | | $506.82 | $642.33 | $762.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.89 / $826.80 / $1,177.72
| Professional | | $638.89 | $826.80 | $1,177.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.01 / $915.42 / $1,317.36
| Professional | | $631.01 | $915.42 | $1,317.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.17 / $889.93 / $1,365.20
| Professional | | $769.17 | $889.93 | $1,365.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.82 / $694.00 / $762.85
| Professional | | $506.82 | $694.00 | $762.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.74 / $805.52 / $1,224.80
| Professional | | $518.74 | $805.52 | $1,224.80 |