- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.83 / $336.83 / $336.83
| Facility | | $336.83 | $336.83 | $336.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.60 / $319.75 / $451.21
| Professional | | $294.60 | $319.75 | $451.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.73 / $391.37 / $606.48
| Professional | | $289.73 | $391.37 | $606.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.51 / $282.19 / $342.93
| Professional | | $216.51 | $282.19 | $342.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.67 / $452.52 / $565.66
| Professional | | $333.67 | $452.52 | $565.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.77 / $327.71 / $496.18
| Professional | | $257.77 | $327.71 | $496.18 |