- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.41 / $647.86 / $779.22
| Professional | | $513.41 | $647.86 | $779.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.12 / $829.09 / $1,377.81
| Professional | | $706.12 | $829.09 | $1,377.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.57 / $959.06 / $1,376.78
| Professional | | $736.57 | $959.06 | $1,376.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.83 / $1,041.09 / $1,597.11
| Professional | | $899.83 | $1,041.09 | $1,597.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.41 / $698.66 / $779.22
| Professional | | $513.41 | $698.66 | $779.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.70 / $840.04 / $1,329.17
| Professional | | $530.70 | $840.04 | $1,329.17 |