- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.42 / $250.28 / $333.71
| Facility | | $217.42 | $250.28 | $333.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.36 / $286.52 / $350.07
| Professional | | $227.36 | $286.52 | $350.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.50 / $446.47 / $533.76
| Professional | | $379.50 | $446.47 | $533.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.23 / $378.23 / $378.23
| Professional | | $378.23 | $378.23 | $378.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.60 / $350.40 / $510.68
| Facility | | $301.60 | $350.40 | $510.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.05 / $571.75 / $2,551.41
| Professional | | $404.05 | $571.75 | $2,551.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.47 / $465.33 / $760.62
| Professional | | $368.47 | $465.33 | $760.62 |