- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.15 / $148.88 / $182.84
| Facility | | $144.15 | $148.88 | $182.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.15 / $144.15 / $146.81
| Professional | | $144.15 | $144.15 | $146.81 |
- 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
- $56.19 / $131.13 / $131.13
| Professional | | $56.19 | $131.13 | $131.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.43 / $137.05 / $206.13
| Facility | | $119.43 | $137.05 | $206.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.23 / $138.15 / $140.50
| Professional | | $111.23 | $138.15 | $140.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.23 / $138.15 / $140.50
| Professional | | $111.23 | $138.15 | $140.50 |