- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.03 / $560.91 / $693.40
| Professional | | $448.03 | $560.91 | $693.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.64 / $728.13 / $1,042.03
| Professional | | $562.64 | $728.13 | $1,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.48 / $830.49 / $1,156.58
| Professional | | $554.48 | $830.49 | $1,156.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.54 / $787.38 / $1,207.89
| Professional | | $680.54 | $787.38 | $1,207.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.03 / $639.79 / $693.40
| Professional | | $448.03 | $639.79 | $693.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.98 / $744.81 / $1,068.82
| Professional | | $526.98 | $744.81 | $1,068.82 |