- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $575.44 / $776.25
| Facility | | $436.52 | $575.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $436.52 / $446.68
| Professional | | $426.58 | $436.52 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $562.34 / $676.08
| Professional | | $501.19 | $562.34 | $676.08 |