- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.35 / $307.98 / $386.63
| Facility | | $307.35 | $307.98 | $386.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.82 / $313.63 / $455.93
| Professional | | $262.82 | $313.63 | $455.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.66 / $636.58 / $1,189.33
| Facility | | $594.66 | $636.58 | $1,189.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.33 / $350.00 / $497.94
| Professional | | $347.33 | $350.00 | $497.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.27 / $401.27 / $401.27
| Facility | | $401.27 | $401.27 | $401.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.93 / $385.66 / $427.77
| Professional | | $292.93 | $385.66 | $427.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.40 / $305.58 / $430.65
| Professional | | $226.40 | $305.58 | $430.65 |