- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.27 / $326.27 / $524.71
| Facility | | $326.27 | $326.27 | $524.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.20 / $312.27 / $343.31
| Professional | | $262.20 | $312.27 | $343.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.51 / $789.45 / $1,105.23
| Facility | | $410.51 | $789.45 | $1,105.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.83 / $442.09 / $635.71
| Professional | | $370.83 | $442.09 | $635.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.03 / $331.03 / $679.08
| Facility | | $331.03 | $331.03 | $679.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.65 / $331.03 / $2,846.21
| Professional | | $241.65 | $331.03 | $2,846.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.53 / $315.08 / $525.13
| Professional | | $221.53 | $315.08 | $525.13 |