- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.91 / $156.88 / $188.25
| Facility | | $102.91 | $156.88 | $188.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.13 / $101.66 / $102.91
| Professional | | $94.13 | $101.66 | $102.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.05 / $169.43 / $188.25
| Facility | | $138.05 | $169.43 | $188.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.60 / $150.60 / $169.43
| Professional | | $150.60 | $150.60 | $169.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.98 / $150.60 / $376.49
| Facility | | $101.98 | $150.60 | $376.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.95 / $180.17 / $751.01
| Professional | | $53.95 | $180.17 | $751.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.71 / $75.30 / $243.54
| Professional | | $52.71 | $75.30 | $243.54 |