- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.57 / $498.66 / $1,064.27
| Facility | | $481.57 | $498.66 | $1,064.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.57 / $488.98 / $582.70
| Professional | | $481.57 | $488.98 | $582.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.10 / $305.18 / $448.40
| Facility | | $260.10 | $305.18 | $448.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.40 / $448.40 / $457.37
| Professional | | $448.40 | $448.40 | $457.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.73 / $456.73 / $484.14
| Facility | | $456.73 | $456.73 | $484.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.14 / $484.14 / $484.14
| Professional | | $484.14 | $484.14 | $484.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.54 / $484.14 / $566.52
| Professional | | $481.54 | $484.14 | $566.52 |