- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.00 / $326.42 / $341.11
| Facility | | $173.00 | $326.42 | $341.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.25 / $164.25 / $190.53
| Professional | | $164.25 | $164.25 | $190.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.68 / $288.39 / $525.60
| Facility | | $180.68 | $288.39 | $525.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.25 / $164.25 / $164.25
| Professional | | $164.25 | $164.25 | $164.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.96 / $154.96 / $224.83
| Facility | | $154.96 | $154.96 | $224.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.25 / $164.25 / $164.25
| Professional | | $164.25 | $164.25 | $164.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.21 / $174.11 / $272.76
| Facility | | $163.21 | $174.11 | $272.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.04 / $180.68 / $248.02
| Professional | | $179.04 | $180.68 | $248.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.25 / $164.25 / $174.11
| Professional | | $164.25 | $164.25 | $174.11 |