- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.25 / $512.57 / $914.90
| Facility | | $503.25 | $512.57 | $914.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.50 / $442.62 / $615.25
| Professional | | $391.50 | $442.62 | $615.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.41 / $564.36 / $564.36
| Professional | | $426.41 | $564.36 | $564.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.88 / $593.78 / $772.76
| Professional | | $395.88 | $593.78 | $772.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.96 / $499.18 / $780.62
| Professional | | $365.96 | $499.18 | $780.62 |