- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.54 / $535.96 / $686.28
| Professional | | $468.54 | $535.96 | $686.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.17 / $740.47 / $1,057.17
| Professional | | $572.17 | $740.47 | $1,057.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.01 / $823.53 / $1,179.53
| Professional | | $566.01 | $823.53 | $1,179.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.44 / $798.84 / $1,225.46
| Professional | | $690.44 | $798.84 | $1,225.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.54 / $538.82 / $686.28
| Professional | | $468.54 | $538.82 | $686.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.95 / $743.78 / $1,099.32
| Professional | | $512.95 | $743.78 | $1,099.32 |