- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.49 / $507.49 / $507.49
| Facility | | $507.49 | $507.49 | $507.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.36 / $465.97 / $507.49
| Professional | | $461.36 | $465.97 | $507.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.45 / $955.51 / $2,362.98
| Facility | | $404.45 | $955.51 | $2,362.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.77 / $505.56 / $1,194.39
| Professional | | $410.77 | $505.56 | $1,194.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.24 / $461.36 / $461.36
| Facility | | $435.24 | $461.36 | $461.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.36 / $461.36 / $461.36
| Professional | | $461.36 | $461.36 | $461.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.00 / $399.67 / $904.27
| Facility | | $322.00 | $399.67 | $904.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.31 / $330.31 / $716.77
| Professional | | $330.31 | $330.31 | $716.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.36 / $461.36 / $461.36
| Professional | | $461.36 | $461.36 | $461.36 |