- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.10 / $585.10 / $585.10
| Facility | | $585.10 | $585.10 | $585.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.59 / $511.97 / $585.10
| Professional | | $487.59 | $511.97 | $585.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.99 / $528.99 / $528.99
| Facility | | $528.99 | $528.99 | $528.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.92 / $528.99 / $528.99
| Professional | | $511.92 | $528.99 | $528.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.99 / $487.59 / $487.59
| Facility | | $459.99 | $487.59 | $487.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.59 / $487.59 / $528.98
| Professional | | $487.59 | $487.59 | $528.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.83 / $487.59 / $555.85
| Professional | | $438.83 | $487.59 | $555.85 |