- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.84 / $474.84 / $885.42
| Facility | | $474.84 | $474.84 | $885.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.83 / $479.58 / $595.20
| Professional | | $474.83 | $479.58 | $595.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.15 / $517.73 / $524.37
| Facility | | $515.15 | $517.73 | $524.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.88 / $516.95 / $521.59
| Professional | | $437.88 | $516.95 | $521.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.53 / $480.53 / $600.66
| Professional | | $480.53 | $480.53 | $600.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.39 / $491.90 / $925.12
| Facility | | $382.39 | $491.90 | $925.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.90 / $547.59 / $594.71
| Professional | | $491.90 | $547.59 | $594.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.84 / $528.60 / $574.09
| Professional | | $474.84 | $528.60 | $574.09 |