- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.04 / $168.41 / $202.72
| Facility | | $152.04 | $168.41 | $202.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.15 / $172.31 / $212.84
| Professional | | $149.15 | $172.31 | $212.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.49 / $179.41 / $229.80
| Professional | | $157.49 | $179.41 | $229.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.27 / $186.63 / $225.21
| Professional | | $106.27 | $186.63 | $225.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.04 / $227.30 / $380.54
| Professional | | $142.04 | $227.30 | $380.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.25 / $175.16 / $257.72
| Professional | | $144.25 | $175.16 | $257.72 |