- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.52 / $743.71 / $743.71
| Professional | | $666.52 | $743.71 | $743.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.86 / $826.77 / $1,301.08
| Professional | | $638.86 | $826.77 | $1,301.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.94 / $842.71 / $1,360.98
| Professional | | $541.94 | $842.71 | $1,360.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.65 / $941.29 / $1,394.45
| Professional | | $785.65 | $941.29 | $1,394.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.52 / $743.71 / $743.71
| Professional | | $666.52 | $743.71 | $743.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.85 / $875.34 / $1,384.93
| Professional | | $626.85 | $875.34 | $1,384.93 |