- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.25 / $591.25 / $2,551.96
| Facility | | $591.25 | $591.25 | $2,551.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.97 / $591.55 / $811.95
| Professional | | $579.97 | $591.55 | $811.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.63 / $635.65 / $671.36
| Facility | | $553.63 | $635.65 | $671.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.71 / $599.71 / $599.71
| Professional | | $599.71 | $599.71 | $599.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.14 / $547.14 / $579.97
| Facility | | $547.14 | $547.14 | $579.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.97 / $579.97 / $579.97
| Professional | | $579.97 | $579.97 | $579.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.74 / $579.99 / $811.98
| Facility | | $493.74 | $579.99 | $811.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.64 / $579.99 / $640.08
| Professional | | $564.64 | $579.99 | $640.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.97 / $579.97 / $684.79
| Professional | | $579.97 | $579.97 | $684.79 |