- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.06 / $555.66 / $563.87
| Professional | | $460.06 | $555.66 | $563.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.50 / $621.83 / $1,209.49
| Professional | | $480.50 | $621.83 | $1,209.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.22 / $528.22 / $611.00
| Facility | | $528.22 | $528.22 | $611.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.75 / $679.52 / $1,007.38
| Professional | | $458.75 | $679.52 | $1,007.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.83 / $677.22 / $1,059.73
| Professional | | $525.83 | $677.22 | $1,059.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.06 / $555.66 / $1,108.63
| Professional | | $460.06 | $555.66 | $1,108.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.61 / $645.09 / $923.83
| Professional | | $456.61 | $645.09 | $923.83 |