- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.83 / $734.38 / $876.55
| Professional | | $581.83 | $734.38 | $876.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.08 / $947.40 / $1,350.02
| Professional | | $732.08 | $947.40 | $1,350.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.38 / $1,051.85 / $1,507.97
| Professional | | $722.38 | $1,051.85 | $1,507.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.70 / $1,020.13 / $1,564.93
| Professional | | $881.70 | $1,020.13 | $1,564.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.83 / $766.50 / $876.55
| Professional | | $581.83 | $766.50 | $876.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.04 / $913.63 / $1,401.75
| Professional | | $596.04 | $913.63 | $1,401.75 |