- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.20 / $155.80 / $186.96
| Facility | | $102.20 | $155.80 | $186.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.48 / $102.20 / $105.94
| Professional | | $93.48 | $102.20 | $105.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.10 / $186.96 / $218.12
| Facility | | $137.10 | $186.96 | $218.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.57 / $149.57 / $168.26
| Professional | | $149.57 | $149.57 | $168.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.28 / $159.02 / $373.91
| Facility | | $101.28 | $159.02 | $373.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.68 / $114.36 / $600.76
| Professional | | $32.68 | $114.36 | $600.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.65 / $45.96 / $137.00
| Professional | | $36.65 | $45.96 | $137.00 |