- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.73 / $262.10 / $300.98
| Professional | | $221.73 | $262.10 | $300.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.49 / $969.05 / $1,147.24
| Facility | | $717.49 | $969.05 | $1,147.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.46 / $331.46 / $458.91
| Professional | | $331.46 | $331.46 | $458.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.52 / $366.26 / $366.26
| Facility | | $293.52 | $366.26 | $366.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.37 / $366.26 / $366.26
| Professional | | $267.37 | $366.26 | $366.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.82 / $290.29 / $421.95
| Professional | | $228.82 | $290.29 | $421.95 |