- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.44 / $544.44 / $873.68
| Professional | | $544.44 | $544.44 | $873.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.48 / $742.29 / $1,181.83
| Professional | | $640.48 | $742.29 | $1,181.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.79 / $833.37 / $1,193.95
| Professional | | $619.79 | $833.37 | $1,193.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.54 / $806.94 / $1,237.89
| Professional | | $626.54 | $806.94 | $1,237.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.44 / $544.44 / $873.68
| Professional | | $544.44 | $544.44 | $873.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.77 / $780.38 / $1,195.30
| Professional | | $537.77 | $780.38 | $1,195.30 |