- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.98 / $261.33 / $321.68
| Professional | | $236.98 | $261.33 | $321.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.85 / $1,035.71 / $1,226.16
| Facility | | $766.85 | $1,035.71 | $1,226.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.58 / $305.39 / $490.48
| Professional | | $259.58 | $305.39 | $490.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.54 / $274.54 / $313.72
| Facility | | $274.54 | $274.54 | $313.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.41 / $200.41 / $200.41
| Professional | | $200.41 | $200.41 | $200.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.56 / $309.74 / $450.97
| Professional | | $244.56 | $309.74 | $450.97 |