- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.44 / $326.89 / $419.54
| Facility | | $288.44 | $326.89 | $419.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.30 / $185.30 / $185.30
| Professional | | $185.30 | $185.30 | $185.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.80 / $416.30 / $485.10
| Professional | | $352.80 | $416.30 | $485.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.58 / $419.54 / $489.47
| Professional | | $384.58 | $419.54 | $489.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.62 / $524.42 / $524.42
| Professional | | $349.62 | $524.42 | $524.42 |