- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.03 / $181.84 / $286.11
| Professional | | $171.03 | $181.84 | $286.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.43 / $212.41 / $358.62
| Professional | | $182.43 | $212.41 | $358.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.02 / $217.02 / $217.02
| Facility | | $217.02 | $217.02 | $217.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.84 / $167.84 / $167.84
| Professional | | $167.84 | $167.84 | $167.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.64 / $272.75 / $536.22
| Professional | | $228.64 | $272.75 | $536.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.49 / $186.40 / $351.95
| Professional | | $180.49 | $186.40 | $351.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.72 / $270.54 / $421.76
| Professional | | $189.72 | $270.54 | $421.76 |