- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.82 / $322.80 / $379.76
| Facility | | $284.82 | $322.80 | $379.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.61 / $330.18 / $440.24
| Professional | | $273.61 | $330.18 | $440.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.83 / $385.61 / $385.61
| Facility | | $316.83 | $385.61 | $385.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.54 / $379.13 / $490.94
| Professional | | $303.54 | $379.13 | $490.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.23 / $378.23 / $378.23
| Professional | | $378.23 | $378.23 | $378.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.78 / $436.72 / $645.94
| Professional | | $341.78 | $436.72 | $645.94 |