- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.41 / $453.90 / $462.89
| Facility | | $449.41 | $453.90 | $462.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $453.90 / $494.35
| Professional | | $449.41 | $453.90 | $494.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.99 / $530.99 / $796.49
| Facility | | $530.99 | $530.99 | $796.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.99 / $530.99 / $541.61
| Professional | | $530.99 | $530.99 | $541.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.37 / $121.37 / $121.37
| Facility | | $121.37 | $121.37 | $121.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.97 / $423.97 / $449.41
| Facility | | $423.97 | $423.97 | $449.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $449.41
| Professional | | $449.41 | $449.41 | $449.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $873.12
| Professional | | $449.41 | $449.41 | $873.12 |