- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.47 / $180.18 / $198.78
| Facility | | $133.47 | $180.18 | $198.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.46 / $133.47 / $146.81
| Professional | | $133.46 | $133.47 | $146.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.03 / $43.72 / $58.82
| Facility | | $36.03 | $43.72 | $58.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.08 / $117.08 / $117.08
| Professional | | $117.08 | $117.08 | $117.08 |
- 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 / $139.59
| Professional | | $131.13 | $131.13 | $139.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.08 / $132.30 / $140.50
| Professional | | $117.08 | $132.30 | $140.50 |