- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.87 / $326.87 / $334.14
| Facility | | $326.87 | $326.87 | $334.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.27 / $257.55 / $357.03
| Professional | | $233.27 | $257.55 | $357.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.56 / $628.88 / $857.26
| Facility | | $497.56 | $628.88 | $857.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.55 / $271.23 / $470.40
| Professional | | $230.55 | $271.23 | $470.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.75 / $314.51 / $551.83
| Professional | | $256.75 | $314.51 | $551.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.31 / $313.85 / $445.57
| Professional | | $270.31 | $313.85 | $445.57 |