- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.59 / $145.44 / $184.73
| Professional | | $117.59 | $145.44 | $184.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.02 / $201.20 / $275.38
| Professional | | $171.02 | $201.20 | $275.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.47 / $205.14 / $253.50
| Facility | | $159.47 | $205.14 | $253.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.78 / $213.50 / $304.20
| Professional | | $164.78 | $213.50 | $304.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.23 / $218.44 / $313.95
| Professional | | $170.23 | $218.44 | $313.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.02 / $214.27 / $311.55
| Professional | | $181.02 | $214.27 | $311.55 |