- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $398.11 / $794.33
| Facility | | $389.05 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $758.58
| Professional | | $288.40 | $398.11 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $741.31
| Professional | | $512.86 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $354.81
| Professional | | $281.84 | $281.84 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $1,174.90
| Facility | | $389.05 | $389.05 | $1,174.90 |