- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.71 / $679.71 / $769.76
| Professional | | $679.71 | $679.71 | $769.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.98 / $709.10 / $1,071.80
| Professional | | $632.98 | $709.10 | $1,071.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.92 / $785.56 / $1,125.46
| Professional | | $661.92 | $785.56 | $1,125.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.85 / $750.66 / $1,151.56
| Professional | | $582.85 | $750.66 | $1,151.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.71 / $679.71 / $769.76
| Professional | | $679.71 | $679.71 | $769.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.50 / $766.52 / $1,035.24
| Professional | | $570.50 | $766.52 | $1,035.24 |