- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.87 / $147.66 / $158.37
| Professional | | $146.87 | $147.66 | $158.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.07 / $187.74 / $279.89
| Professional | | $145.07 | $187.74 | $279.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.91 / $157.91 / $157.91
| Facility | | $157.91 | $157.91 | $157.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.71 / $213.88 / $312.56
| Professional | | $153.71 | $213.88 | $312.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.08 / $194.58 / $387.91
| Professional | | $151.08 | $194.58 | $387.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.87 / $147.66 / $158.37
| Professional | | $146.87 | $147.66 | $158.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.51 / $216.74 / $274.60
| Professional | | $136.51 | $216.74 | $274.60 |