- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.60 / $223.61 / $347.47
| Facility | | $202.60 | $223.61 | $347.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.21 / $232.58 / $269.39
| Professional | | $179.21 | $232.58 | $269.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.36 / $220.36 / $302.41
| Facility | | $220.36 | $220.36 | $302.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.48 / $249.00 / $339.49
| Professional | | $208.48 | $249.00 | $339.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.60 / $326.72 / $1,382.00
| Facility | | $202.60 | $326.72 | $1,382.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.05 / $289.14 / $637.59
| Professional | | $228.05 | $289.14 | $637.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.05 / $262.44 / $437.40
| Professional | | $228.05 | $262.44 | $437.40 |