- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.06 / $311.74 / $366.75
| Facility | | $275.06 | $311.74 | $366.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.67 / $311.74 / $381.81
| Professional | | $264.67 | $311.74 | $381.81 |
- 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
- $309.04 / $379.47 / $479.53
| Professional | | $309.04 | $379.47 | $479.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.36 / $442.59 / $527.23
| Professional | | $360.36 | $442.59 | $527.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.72 / $408.39 / $612.60
| Professional | | $326.72 | $408.39 | $612.60 |