- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.41 / $610.76 / $623.41
| Facility | | $534.41 | $610.76 | $623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.96 / $534.41 / $687.10
| Professional | | $508.96 | $534.41 | $687.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.44 / $373.44 / $410.78
| Facility | | $373.44 | $373.44 | $410.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.23 / $508.96 / $508.96
| Facility | | $342.23 | $508.96 | $508.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.96 / $508.96 / $508.96
| Professional | | $508.96 | $508.96 | $508.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.60 / $508.96 / $651.47
| Professional | | $488.60 | $508.96 | $651.47 |