- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.12 / $704.82 / $769.71
| Professional | | $526.12 | $704.82 | $769.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.32 / $804.35 / $1,216.23
| Professional | | $623.32 | $804.35 | $1,216.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.78 / $941.54 / $1,424.11
| Professional | | $662.78 | $941.54 | $1,424.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.31 / $919.02 / $1,409.82
| Professional | | $794.31 | $919.02 | $1,409.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.12 / $674.88 / $769.71
| Professional | | $526.12 | $674.88 | $769.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.35 / $761.76 / $1,299.28
| Professional | | $525.35 | $761.76 | $1,299.28 |