- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.13 / $312.89 / $771.45
| Facility | | $279.13 | $312.89 | $771.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.00 / $312.89 / $506.33
| Professional | | $261.00 | $312.89 | $506.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Professional | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.71 / $426.03 / $426.03
| Facility | | $354.71 | $426.03 | $426.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.60 / $310.30 / $329.52
| Professional | | $274.60 | $310.30 | $329.52 |