- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.69 / $579.13 / $600.30
| Professional | | $529.69 | $579.13 | $600.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.59 / $60.59 / $126.43
| Professional | | $60.59 | $60.59 | $126.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.00 / $635.63 / $807.25
| Professional | | $565.00 | $635.63 | $807.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.24 / $860.24 / $1,030.66
| Professional | | $860.24 | $860.24 | $1,030.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.25 / $776.88 / $988.75
| Professional | | $706.25 | $776.88 | $988.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.69 / $702.36 / $1,200.61
| Facility | | $529.69 | $702.36 | $1,200.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.00 / $1,235.94 / $1,695.00
| Professional | | $968.00 | $1,235.94 | $1,695.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.38 / $753.57 / $1,058.81
| Facility | | $494.38 | $753.57 | $1,058.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.38 / $753.57 / $1,058.81
| Professional | | $494.38 | $753.57 | $1,058.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.63 / $391.97 / $812.19
| Professional | | $296.63 | $391.97 | $812.19 |