- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.40 / $590.40 / $602.64
| Facility | | $590.40 | $590.40 | $602.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.40 / $590.40 / $590.40
| Professional | | $590.40 | $590.40 | $590.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.14 / $693.02 / $746.75
| Facility | | $575.14 | $693.02 | $746.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.96 / $508.96 / $508.96
| Professional | | $508.96 | $508.96 | $508.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.66 / $1,007.96 / $1,447.07
| Facility | | $735.66 | $1,007.96 | $1,447.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.51 / $508.96 / $508.96
| Professional | | $483.51 | $508.96 | $508.96 |