- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.79 / $548.55 / $1,711.51
| Facility | | $545.79 | $548.55 | $1,711.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $545.79 / $645.49
| Professional | | $529.89 | $545.79 | $645.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.11 / $663.85 / $933.99
| Facility | | $569.11 | $663.85 | $933.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.06 / $535.85 / $535.85
| Professional | | $509.06 | $535.85 | $535.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.60 / $529.89 / $529.89
| Professional | | $472.60 | $529.89 | $529.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.89 / $685.70 / $1,526.37
| Facility | | $529.89 | $685.70 | $1,526.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $545.79 / $635.86
| Professional | | $529.89 | $545.79 | $635.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.25 / $786.85 / $798.87
| Professional | | $603.25 | $786.85 | $798.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $562.21
| Professional | | $529.89 | $529.89 | $562.21 |