- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.64 / $331.64 / $331.64
| Facility | | $331.64 | $331.64 | $331.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.51 / $334.53 / $530.50
| Professional | | $267.51 | $334.53 | $530.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.86 / $403.17 / $658.10
| Professional | | $304.86 | $403.17 | $658.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.77 / $314.53 / $381.75
| Professional | | $240.77 | $314.53 | $381.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.96 / $439.92 / $544.11
| Professional | | $360.96 | $439.92 | $544.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.17 / $320.39 / $484.20
| Professional | | $250.17 | $320.39 | $484.20 |