- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.78 / $754.29 / $903.31
| Professional | | $598.78 | $754.29 | $903.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.55 / $973.89 / $1,386.63
| Professional | | $752.55 | $973.89 | $1,386.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.27 / $1,083.97 / $1,549.77
| Professional | | $741.27 | $1,083.97 | $1,549.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.60 / $1,047.78 / $1,607.35
| Professional | | $905.60 | $1,047.78 | $1,607.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.78 / $805.16 / $903.31
| Professional | | $598.78 | $805.16 | $903.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.52 / $993.48 / $1,440.22
| Professional | | $686.52 | $993.48 | $1,440.22 |