- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.26 / $285.26 / $288.06
| Facility | | $285.26 | $285.26 | $288.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.55 / $285.26 / $318.23
| Professional | | $261.55 | $285.26 | $318.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.51 / $46.51 / $46.51
| Facility | | $46.51 | $46.51 | $46.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.25 / $356.25 / $445.31
| Professional | | $356.25 | $356.25 | $445.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.28 / $262.88 / $328.60
| Professional | | $216.28 | $262.88 | $328.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.85 / $298.49 / $369.30
| Professional | | $267.85 | $298.49 | $369.30 |