- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $229.09 / $302.00
| Professional | | $199.53 | $229.09 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $223.87 / $257.04
| Professional | | $204.17 | $223.87 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $323.59 / $426.58
| Professional | | $281.84 | $323.59 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $213.80
| Facility | | $117.49 | $117.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $125.89 / $229.09
| Professional | | $117.49 | $125.89 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Professional | | $141.25 | $141.25 | $141.25 |