- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.56 / $180.49 / $206.32
| Professional | | $176.56 | $180.49 | $206.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.82 / $195.51 / $195.51
| Professional | | $192.82 | $195.51 | $195.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.96 / $160.96 / $215.49
| Facility | | $160.96 | $160.96 | $215.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.82 / $160.96 / $215.49
| Professional | | $136.82 | $160.96 | $215.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.62 / $146.11 / $206.80
| Professional | | $132.62 | $146.11 | $206.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.99 / $258.99 / $258.99
| Professional | | $258.99 | $258.99 | $258.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.18 / $160.09 / $222.65
| Professional | | $120.18 | $160.09 | $222.65 |