- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.54 / $583.44 / $791.22
| Professional | | $523.54 | $583.44 | $791.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.84 / $848.73 / $1,224.43
| Professional | | $655.84 | $848.73 | $1,224.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.50 / $954.07 / $1,362.46
| Professional | | $657.50 | $954.07 | $1,362.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.67 / $925.22 / $1,419.33
| Professional | | $799.67 | $925.22 | $1,419.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.96 / $615.86 / $791.22
| Professional | | $522.96 | $615.86 | $791.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.33 / $873.89 / $1,277.34
| Professional | | $601.33 | $873.89 | $1,277.34 |