- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.59 / $495.58 / $562.19
| Professional | | $462.59 | $495.58 | $562.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.77 / $546.79 / $823.25
| Professional | | $464.77 | $546.79 | $823.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.91 / $459.91 / $1,835.00
| Facility | | $459.91 | $459.91 | $1,835.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.79 / $592.45 / $885.65
| Professional | | $420.79 | $592.45 | $885.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.58 / $575.16 / $900.03
| Professional | | $446.58 | $575.16 | $900.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.01 / $495.58 / $955.05
| Professional | | $463.01 | $495.58 | $955.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.46 / $599.29 / $801.52
| Professional | | $416.46 | $599.29 | $801.52 |