- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.20 / $445.14 / $719.82
| Facility | | $332.20 | $445.14 | $719.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.74 / $298.04 / $472.56
| Professional | | $264.74 | $298.04 | $472.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.95 / $329.37 / $329.37
| Professional | | $279.95 | $329.37 | $329.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Professional | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.06 / $329.52 / $334.54
| Professional | | $302.06 | $329.52 | $334.54 |