- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.31 / $311.31 / $328.82
| Facility | | $311.31 | $311.31 | $328.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.29 / $294.75 / $390.19
| Professional | | $250.29 | $294.75 | $390.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.56 / $500.68 / $592.78
| Facility | | $486.56 | $500.68 | $592.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.61 / $368.60 / $374.92
| Professional | | $304.61 | $368.60 | $374.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Facility | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.42 / $307.55 / $580.50
| Professional | | $261.42 | $307.55 | $580.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.53 / $239.36 / $358.36
| Professional | | $166.53 | $239.36 | $358.36 |