- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.59 / $192.40 / $215.55
| Facility | | $188.59 | $192.40 | $215.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.99 / $207.57 / $323.62
| Professional | | $185.99 | $207.57 | $323.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.24 / $448.00 / $638.40
| Professional | | $281.24 | $448.00 | $638.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.88 / $298.86 / $423.87
| Professional | | $157.88 | $298.86 | $423.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.28 / $231.28 / $231.28
| Facility | | $231.28 | $231.28 | $231.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.20 / $283.14 / $489.77
| Professional | | $208.20 | $283.14 | $489.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.45 / $256.98 / $638.35
| Professional | | $217.45 | $256.98 | $638.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.47 / $294.83 / $379.18
| Professional | | $191.47 | $294.83 | $379.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.27 / $303.80 / $493.58
| Professional | | $203.27 | $303.80 | $493.58 |