- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.64 / $334.24 / $377.37
| Facility | | $320.64 | $334.24 | $377.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.00 / $320.64 / $420.50
| Professional | | $147.00 | $320.64 | $420.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.51 / $630.17 / $1,145.11
| Facility | | $369.51 | $630.17 | $1,145.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.38 / $353.38 / $353.38
| Facility | | $353.38 | $353.38 | $353.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.05 / $361.76 / $525.62
| Professional | | $288.05 | $361.76 | $525.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.26 / $296.51 / $481.86
| Professional | | $231.26 | $296.51 | $481.86 |