- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.78 / $492.70 / $506.34
| Professional | | $418.78 | $492.70 | $506.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.31 / $550.40 / $851.92
| Professional | | $425.31 | $550.40 | $851.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.67 / $466.67 / $699.00
| Facility | | $466.67 | $466.67 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.97 / $552.71 / $895.69
| Professional | | $391.97 | $552.71 | $895.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.13 / $595.20 / $931.37
| Professional | | $462.13 | $595.20 | $931.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.78 / $492.70 / $991.50
| Professional | | $418.78 | $492.70 | $991.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.04 / $575.69 / $882.82
| Professional | | $397.04 | $575.69 | $882.82 |