- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.36 / $294.36 / $300.82
| Facility | | $294.36 | $294.36 | $300.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.30 / $272.52 / $294.36
| Professional | | $245.30 | $272.52 | $294.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.41 / $262.41 / $262.41
| Facility | | $262.41 | $262.41 | $262.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.33 / $262.41 / $262.41
| Professional | | $256.33 | $262.41 | $262.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.42 / $245.30 / $245.30
| Facility | | $231.42 | $245.30 | $245.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.30 / $245.30 / $266.13
| Professional | | $245.30 | $245.30 | $266.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.77 / $245.30 / $282.10
| Professional | | $220.77 | $245.30 | $282.10 |