- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.06 / $188.84 / $318.81
| Professional | | $168.06 | $188.84 | $318.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.11 / $160.11 / $282.20
| Facility | | $160.11 | $160.11 | $282.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.04 / $171.98 / $193.48
| Professional | | $144.04 | $171.98 | $193.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.31 / $183.31 / $183.31
| Professional | | $183.31 | $183.31 | $183.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.68 / $209.42 / $378.56
| Facility | | $168.68 | $209.42 | $378.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.52 / $224.40 / $1,287.73
| Professional | | $179.52 | $224.40 | $1,287.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.20 / $213.18 / $403.92
| Professional | | $178.20 | $213.18 | $403.92 |