- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.22 / $206.70 / $233.06
| Professional | | $194.22 | $206.70 | $233.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $221.17 / $742.47
| Facility | | $0.02 | $221.17 | $742.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.50 / $175.50 / $222.30
| Professional | | $175.50 | $175.50 | $222.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.70 / $206.70 / $206.70
| Facility | | $206.70 | $206.70 | $206.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.70 / $206.70 / $206.70
| Professional | | $206.70 | $206.70 | $206.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.58 / $234.00 / $744.30
| Facility | | $203.58 | $234.00 | $744.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.90 / $234.00 / $236.34
| Professional | | $198.90 | $234.00 | $236.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.90 / $234.00 / $236.34
| Professional | | $198.90 | $234.00 | $236.34 |