- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.71 / $236.55 / $310.45
| Professional | | $228.71 | $236.55 | $310.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.10 / $999.59 / $1,183.40
| Facility | | $740.10 | $999.59 | $1,183.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.89 / $341.89 / $473.37
| Professional | | $341.89 | $341.89 | $473.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.11 / $246.11 / $302.76
| Facility | | $246.11 | $246.11 | $302.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.66 / $246.10 / $246.11
| Professional | | $179.66 | $246.10 | $246.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.41 / $261.14 / $435.25
| Professional | | $178.41 | $261.14 | $435.25 |