- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.24 / $256.83 / $308.93
| Professional | | $228.24 | $256.83 | $308.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.49 / $210.49 / $242.48
| Professional | | $210.49 | $210.49 | $242.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.16 / $238.16 / $238.16
| Facility | | $238.16 | $238.16 | $238.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.44 / $238.16 / $238.16
| Professional | | $202.44 | $238.16 | $238.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.76 / $252.02 / $356.71
| Professional | | $228.76 | $252.02 | $356.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.53 / $193.43 / $339.30
| Professional | | $141.53 | $193.43 | $339.30 |