- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.70 / $655.97 / $774.04
| Professional | | $442.70 | $655.97 | $774.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.62 / $554.36 / $1,476.82
| Facility | | $434.62 | $554.36 | $1,476.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.83 / $545.83 / $545.83
| Professional | | $545.83 | $545.83 | $545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.56 / $286.56 / $409.37
| Professional | | $286.56 | $286.56 | $409.37 |