- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.22 / $381.22 / $391.45
| Facility | | $381.22 | $381.22 | $391.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.77 / $352.96 / $493.33
| Professional | | $293.77 | $352.96 | $493.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.10 / $146.91 / $263.70
| Facility | | $130.10 | $146.91 | $263.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.22 / $356.83 / $594.73
| Professional | | $332.22 | $356.83 | $594.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $396.27
| Facility | | $330.77 | $330.77 | $396.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.14 / $330.77 / $506.25
| Professional | | $281.14 | $330.77 | $506.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.24 / $291.51 / $526.67
| Professional | | $208.24 | $291.51 | $526.67 |