- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $190.55 / $234.42
| Facility | | $151.36 | $190.55 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $208.93
| Professional | | $120.23 | $151.36 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $302.00 / $338.84
| Professional | | $229.09 | $302.00 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $245.47 / $371.54
| Professional | | $181.97 | $245.47 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $190.55 / $380.19
| Facility | | $173.78 | $190.55 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $346.74 / $1,148.15
| Professional | | $190.55 | $346.74 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $331.13 / $457.09
| Professional | | $154.88 | $331.13 | $457.09 |