- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.48 / $501.48 / $782.31
| Facility | | $501.48 | $501.48 | $782.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.33 / $501.48 / $501.48
| Professional | | $451.33 | $501.48 | $501.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.17 / $370.17 / $370.17
| Facility | | $370.17 | $370.17 | $370.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.66 / $370.17 / $411.74
| Professional | | $351.66 | $370.17 | $411.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.45 / $643.45 / $804.31
| Professional | | $643.45 | $643.45 | $804.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.48 / $501.48 / $921.47
| Facility | | $501.48 | $501.48 | $921.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.48 / $506.76 / $633.44
| Professional | | $501.48 | $506.76 | $633.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.71 / $316.72 / $527.87
| Professional | | $221.71 | $316.72 | $527.87 |