- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.86 / $306.86 / $361.01
| Facility | | $306.86 | $306.86 | $361.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.19 / $309.70 / $454.01
| Professional | | $258.19 | $309.70 | $454.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.54 / $623.24 / $1,186.61
| Facility | | $589.54 | $623.24 | $1,186.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.57 / $326.91 / $465.63
| Professional | | $321.57 | $326.91 | $465.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.61 / $380.61 / $380.61
| Facility | | $380.61 | $380.61 | $380.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.85 / $277.85 / $619.03
| Professional | | $277.85 | $277.85 | $619.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.63 / $290.10 / $445.23
| Professional | | $221.63 | $290.10 | $445.23 |