- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.16 / $634.76 / $754.29
| Professional | | $501.16 | $634.76 | $754.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.13 / $816.76 / $1,165.09
| Professional | | $631.13 | $816.76 | $1,165.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.41 / $905.52 / $1,301.59
| Professional | | $624.41 | $905.52 | $1,301.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.92 / $880.38 / $1,350.56
| Professional | | $760.92 | $880.38 | $1,350.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.16 / $681.27 / $754.29
| Professional | | $501.16 | $681.27 | $754.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.04 / $808.22 / $1,213.00
| Professional | | $569.04 | $808.22 | $1,213.00 |