- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.10 / $362.10 / $434.52
| Facility | | $362.10 | $362.10 | $434.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.10 / $376.31 / $393.75
| Professional | | $362.10 | $376.31 | $393.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.04 / $427.04 / $427.04
| Professional | | $427.04 | $427.04 | $427.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.74 / $316.74 / $316.74
| Facility | | $316.74 | $316.74 | $316.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.19 / $316.74 / $326.24
| Professional | | $52.19 | $316.74 | $326.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.66 / $276.39 / $583.03
| Professional | | $168.66 | $276.39 | $583.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.96 / $565.03 / $719.12
| Professional | | $509.96 | $565.03 | $719.12 |