- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.35 / $137.54 / $145.13
| Facility | | $132.35 | $137.54 | $145.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.05 / $125.35 / $303.33
| Professional | | $106.05 | $125.35 | $303.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.53 / $175.53 / $198.78
| Facility | | $175.53 | $175.53 | $198.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.83 / $157.60 / $251.17
| Professional | | $124.83 | $157.60 | $251.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.16 / $152.16 / $152.16
| Facility | | $152.16 | $152.16 | $152.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.40 / $181.01 / $295.58
| Professional | | $127.40 | $181.01 | $295.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.88 / $159.71 / $252.04
| Professional | | $120.88 | $159.71 | $252.04 |