- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.41 / $453.90 / $483.65
| Facility | | $449.41 | $453.90 | $483.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $489.85
| Professional | | $449.41 | $449.41 | $489.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.82 / $561.23 / $949.55
| Facility | | $466.82 | $561.23 | $949.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $599.87
| Professional | | $449.41 | $449.41 | $599.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.69 / $449.41 / $449.41
| Facility | | $436.69 | $449.41 | $449.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $508.76
| Professional | | $449.41 | $449.41 | $508.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $584.23
| Professional | | $449.41 | $449.41 | $584.23 |