- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $912.01
| Facility | | $489.78 | $575.44 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $213.80 / $257.04
| Professional | | $190.55 | $213.80 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $70.79
| Professional | | $50.12 | $50.12 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $537.03
| Facility | | $223.87 | $223.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $380.19 / $588.84
| Professional | | $295.12 | $380.19 | $588.84 |