- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.52 / $440.52 / $608.34
| Facility | | $440.52 | $440.52 | $608.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.77 / $440.52 / $440.52
| Professional | | $209.77 | $440.52 | $440.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.66 / $419.54 / $471.99
| Professional | | $314.66 | $419.54 | $471.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.66 / $314.66 / $349.62
| Facility | | $314.66 | $314.66 | $349.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.84 / $209.77 / $350.16
| Professional | | $146.84 | $209.77 | $350.16 |