- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.27 / $284.27 / $364.79
| Facility | | $281.27 | $284.27 | $364.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.19 / $285.43 / $422.01
| Professional | | $247.19 | $285.43 | $422.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.77 / $584.92 / $1,041.54
| Facility | | $520.77 | $584.92 | $1,041.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.52 / $306.70 / $462.80
| Professional | | $301.52 | $306.70 | $462.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.42 / $340.42 / $340.42
| Facility | | $340.42 | $340.42 | $340.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.51 / $340.42 / $351.24
| Professional | | $248.51 | $340.42 | $351.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.65 / $280.57 / $397.22
| Professional | | $209.65 | $280.57 | $397.22 |