- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.71 / $560.58 / $1,108.80
| Facility | | $520.71 | $560.58 | $1,108.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.27 / $508.46 / $520.71
| Professional | | $499.27 | $508.46 | $520.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.91 / $873.41 / $1,631.05
| Facility | | $539.91 | $873.41 | $1,631.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.50 / $520.71 / $520.71
| Professional | | $510.50 | $520.71 | $520.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $520.71
| Facility | | $520.71 | $520.71 | $520.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $520.71
| Professional | | $520.71 | $520.71 | $520.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.50 / $510.50 / $600.35
| Professional | | $510.50 | $510.50 | $600.35 |