- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.61 / $227.38 / $294.04
| Professional | | $216.61 | $227.38 | $294.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.93 / $946.74 / $1,120.83
| Facility | | $700.93 | $946.74 | $1,120.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.24 / $323.81 / $448.34
| Professional | | $275.24 | $323.81 | $448.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.57 / $236.57 / $286.76
| Facility | | $236.57 | $236.57 | $286.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.70 / $236.56 / $236.57
| Professional | | $172.70 | $236.56 | $236.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.50 / $247.34 / $412.23
| Professional | | $171.50 | $247.34 | $412.23 |