- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.89 / $798.87 / $1,214.28
| Facility | | $529.89 | $798.87 | $1,214.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $582.88
| Professional | | $529.89 | $529.89 | $582.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.90 / $529.89 / $552.17
| Facility | | $499.90 | $529.89 | $552.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Professional | | $529.89 | $529.89 | $529.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Facility | | $529.89 | $529.89 | $529.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $539.89 / $539.89
| Professional | | $529.89 | $539.89 | $539.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $561.67
| Professional | | $529.89 | $529.89 | $561.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $532.58 / $532.58
| Professional | | $529.89 | $532.58 | $532.58 |