- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.33 / $130.33 / $177.05
| Facility | | $130.33 | $130.33 | $177.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.31 / $145.50 / $221.31
| Professional | | $106.31 | $145.50 | $221.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.42 / $376.14 / $476.79
| Facility | | $250.42 | $376.14 | $476.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.79 / $159.41 / $211.56
| Professional | | $124.79 | $159.41 | $211.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.56 / $187.08 / $338.60
| Professional | | $118.56 | $187.08 | $338.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.87 / $199.15 / $284.61
| Professional | | $154.87 | $199.15 | $284.61 |