- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.65 / $165.90 / $181.38
| Professional | | $151.65 | $165.90 | $181.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.35 / $173.21 / $173.21
| Professional | | $165.35 | $173.21 | $173.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.98 / $123.98 / $126.46
| Facility | | $123.98 | $123.98 | $126.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.38 / $123.98 / $126.46
| Professional | | $105.38 | $123.98 | $126.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.26 / $132.49 / $187.52
| Professional | | $120.26 | $132.49 | $187.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.73 / $194.73 / $194.73
| Professional | | $194.73 | $194.73 | $194.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.38 / $124.14 / $177.78
| Professional | | $100.38 | $124.14 | $177.78 |