- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.94 / $720.94 / $815.70
| Professional | | $720.94 | $720.94 | $815.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.65 / $752.27 / $1,135.81
| Professional | | $670.65 | $752.27 | $1,135.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.02 / $832.92 / $1,193.31
| Professional | | $702.02 | $832.92 | $1,193.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.66 / $795.50 / $1,220.33
| Professional | | $617.66 | $795.50 | $1,220.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.94 / $720.94 / $815.70
| Professional | | $720.94 | $720.94 | $815.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.36 / $838.10 / $1,096.93
| Professional | | $649.36 | $838.10 | $1,096.93 |