- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.63 / $576.16 / $787.83
| Professional | | $521.63 | $576.16 | $787.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.25 / $850.56 / $1,210.55
| Professional | | $657.25 | $850.56 | $1,210.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.52 / $945.39 / $1,355.39
| Professional | | $648.52 | $945.39 | $1,355.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.60 / $914.72 / $1,403.24
| Professional | | $790.60 | $914.72 | $1,403.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.63 / $576.16 / $787.83
| Professional | | $521.63 | $576.16 | $787.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.20 / $863.33 / $1,259.80
| Professional | | $593.20 | $863.33 | $1,259.80 |