- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.88 / $550.88 / $6,249.99
| Professional | | $550.88 | $550.88 | $6,249.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.67 / $526.82 / $551.50
| Professional | | $484.67 | $526.82 | $551.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.91 / $564.91 / $699.00
| Facility | | $564.91 | $564.91 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.40 / $791.99 / $1,053.20
| Professional | | $562.40 | $791.99 | $1,053.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.63 / $722.05 / $1,129.88
| Professional | | $560.63 | $722.05 | $1,129.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.88 / $550.88 / $6,249.99
| Professional | | $550.88 | $550.88 | $6,249.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.48 / $679.30 / $1,020.60
| Professional | | $468.48 | $679.30 | $1,020.60 |