- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.11 / $199.43 / $239.32
| Facility | | $154.11 | $199.43 | $239.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.11 / $182.71 / $216.88
| Professional | | $144.11 | $182.71 | $216.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.32 / $197.36 / $299.17
| Professional | | $153.32 | $197.36 | $299.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.06 / $141.06 / $141.06
| Professional | | $141.06 | $141.06 | $141.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.27 / $245.94 / $433.64
| Professional | | $136.27 | $245.94 | $433.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.67 / $291.52 / $505.85
| Professional | | $236.67 | $291.52 | $505.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.36 / $231.40 / $294.50
| Professional | | $210.36 | $231.40 | $294.50 |