- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.20 / $606.61 / $610.51
| Facility | | $534.20 | $606.61 | $610.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.76 / $534.20 / $686.82
| Professional | | $508.76 | $534.20 | $686.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.64 / $452.64 / $453.00
| Facility | | $452.64 | $452.64 | $453.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.87 / $508.76 / $508.76
| Facility | | $394.87 | $508.76 | $508.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.76 / $508.76 / $508.76
| Professional | | $508.76 | $508.76 | $508.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.41 / $508.76 / $651.21
| Professional | | $488.41 | $508.76 | $651.21 |