- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.31 / $251.27 / $305.85
| Professional | | $225.31 | $251.27 | $305.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.09 / $984.72 / $1,165.79
| Facility | | $729.09 | $984.72 | $1,165.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.35 / $271.00 / $453.22
| Professional | | $230.35 | $271.00 | $453.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.29 / $360.86 / $360.86
| Facility | | $298.29 | $360.86 | $360.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.43 / $360.86 / $360.86
| Professional | | $263.43 | $360.86 | $360.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.52 / $294.49 / $428.77
| Professional | | $232.52 | $294.49 | $428.77 |