- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.22 / $331.51 / $335.70
| Professional | | $244.22 | $331.51 | $335.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.26 / $1,067.35 / $1,263.61
| Facility | | $790.26 | $1,067.35 | $1,263.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.68 / $293.74 / $491.26
| Professional | | $249.68 | $293.74 | $491.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.31 / $373.57 / $373.57
| Facility | | $323.31 | $373.57 | $373.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.70 / $373.57 / $373.57
| Professional | | $272.70 | $373.57 | $373.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.36 / $276.36 / $276.36
| Facility | | $276.36 | $276.36 | $276.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.34 / $278.85 / $464.75
| Professional | | $236.34 | $278.85 | $464.75 |