- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.62 / $461.62 / $512.40
| Facility | | $461.62 | $461.62 | $512.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.62 / $461.62 / $512.40
| Professional | | $461.62 | $461.62 | $512.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.09 / $334.09 / $367.50
| Facility | | $334.09 | $334.09 | $367.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.30 / $506.88 / $506.88
| Facility | | $315.30 | $506.88 | $506.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.88 / $506.88 / $506.88
| Professional | | $506.88 | $506.88 | $506.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.57 / $502.81 / $543.08
| Professional | | $452.57 | $502.81 | $543.08 |