- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.35 / $580.87 / $695.17
| Professional | | $525.35 | $580.87 | $695.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.42 / $793.68 / $1,207.86
| Professional | | $686.42 | $793.68 | $1,207.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.33 / $891.24 / $1,294.41
| Professional | | $705.33 | $891.24 | $1,294.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.50 / $862.27 / $1,322.76
| Professional | | $669.50 | $862.27 | $1,322.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.35 / $695.17 / $695.17
| Professional | | $525.35 | $695.17 | $695.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.24 / $914.37 / $1,200.91
| Professional | | $662.24 | $914.37 | $1,200.91 |