- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.00 / $298.63 / $302.41
| Professional | | $220.00 | $298.63 | $302.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.90 / $961.51 / $1,138.31
| Facility | | $711.90 | $961.51 | $1,138.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.98 / $283.51 / $455.33
| Professional | | $240.98 | $283.51 | $455.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.24 / $319.76 / $319.76
| Facility | | $291.24 | $319.76 | $319.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.42 / $233.42 / $233.42
| Professional | | $233.42 | $233.42 | $233.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.89 / $251.20 / $418.66
| Professional | | $212.89 | $251.20 | $418.66 |