- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.10 / $155.47 / $155.47
| Facility | | $143.10 | $155.47 | $155.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.01 / $145.86 / $194.48
| Professional | | $115.01 | $145.86 | $194.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.40 / $215.40 / $392.03
| Facility | | $215.40 | $215.40 | $392.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.86 / $164.86 / $280.10
| Professional | | $164.86 | $164.86 | $280.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.10 / $147.10 / $147.10
| Facility | | $147.10 | $147.10 | $147.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.38 / $125.04 / $147.10
| Professional | | $107.38 | $125.04 | $147.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.78 / $16.19 / $44.46
| Professional | | $11.78 | $16.19 | $44.46 |