- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.28 / $176.59 / $207.75
| Facility | | $151.28 | $176.59 | $207.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.68 / $201.70 / $453.02
| Professional | | $130.68 | $201.70 | $453.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.44 / $269.74 / $444.57
| Professional | | $212.44 | $269.74 | $444.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.69 / $158.75 / $191.47
| Professional | | $120.69 | $158.75 | $191.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.32 / $300.06 / $337.78
| Professional | | $177.32 | $300.06 | $337.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.72 / $218.83 / $331.18
| Professional | | $182.72 | $218.83 | $331.18 |