- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.60 / $202.48 / $209.05
| Professional | | $169.60 | $202.48 | $209.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.30 / $244.68 / $346.10
| Professional | | $195.30 | $244.68 | $346.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.58 / $192.58 / $699.00
| Facility | | $192.58 | $192.58 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.32 / $255.22 / $363.42
| Professional | | $194.32 | $255.22 | $363.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.74 / $241.80 / $378.37
| Professional | | $187.74 | $241.80 | $378.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.60 / $202.48 / $388.88
| Professional | | $169.60 | $202.48 | $388.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.01 / $241.80 / $366.09
| Professional | | $167.01 | $241.80 | $366.09 |