- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $218.78 / $223.87
| Professional | | $208.93 | $218.78 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $281.84
| Professional | | $199.53 | $199.53 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $234.42 / $331.13
| Facility | | $213.80 | $234.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $234.42 / $331.13
| Professional | | $213.80 | $234.42 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $245.47 / $316.23
| Facility | | $123.03 | $245.47 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $199.53 / $323.59
| Professional | | $134.90 | $199.53 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $95.50 / $239.88
| Professional | | $83.18 | $95.50 | $239.88 |