- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.17 / $145.56 / $177.20
| Facility | | $109.17 | $145.56 | $177.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.29 / $132.90 / $177.20
| Professional | | $104.29 | $132.90 | $177.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.82 / $295.31 / $363.18
| Professional | | $225.82 | $295.31 | $363.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.77 / $203.46 / $242.57
| Professional | | $162.77 | $203.46 | $242.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.60 / $150.62 / $231.82
| Facility | | $125.60 | $150.62 | $231.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.98 / $168.94 / $911.03
| Professional | | $105.98 | $168.94 | $911.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.00 / $141.38 / $264.16
| Professional | | $93.00 | $141.38 | $264.16 |