- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.56 / $176.55 / $275.72
| Facility | | $126.56 | $176.55 | $275.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.46 / $133.47 / $215.98
| Professional | | $133.46 | $133.47 | $215.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.47 / $207.20 / $424.37
| Facility | | $133.47 | $207.20 | $424.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.12 / $120.12 / $140.50
| Professional | | $120.12 | $120.12 | $140.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.13 / $131.13 / $131.13
| Facility | | $131.13 | $131.13 | $131.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.13 / $131.13 / $131.13
| Professional | | $131.13 | $131.13 | $131.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.08 / $134.63 / $140.50
| Professional | | $117.08 | $134.63 | $140.50 |