- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.48 / $321.73 / $363.06
| Professional | | $318.48 | $321.73 | $363.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.32 / $228.02 / $285.02
| Facility | | $222.32 | $228.02 | $285.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.75 / $235.67 / $391.80
| Professional | | $176.75 | $235.67 | $391.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.52 / $289.52 / $554.05
| Professional | | $289.52 | $289.52 | $554.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.23 / $362.37 / $1,918.67
| Facility | | $292.23 | $362.37 | $1,918.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.75 / $362.39 / $526.76
| Professional | | $310.75 | $362.39 | $526.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.75 / $364.68 / $493.12
| Professional | | $310.75 | $364.68 | $493.12 |