- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.09 / $148.19 / $154.72
| Facility | | $105.09 | $148.19 | $154.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.53 / $154.72 / $154.72
| Professional | | $102.53 | $154.72 | $154.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.12 / $354.12 / $354.12
| Facility | | $354.12 | $354.12 | $354.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.28 / $161.60 / $190.12
| Professional | | $129.28 | $161.60 | $190.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.20 / $263.17 / $270.33
| Facility | | $216.20 | $263.17 | $270.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.64 / $144.22 / $204.40
| Professional | | $79.64 | $144.22 | $204.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.80 / $138.18 / $207.60
| Professional | | $83.80 | $138.18 | $207.60 |