- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.32 / $150.32 / $152.72
| Facility | | $150.32 | $150.32 | $152.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.22 / $126.86 / $188.15
| Professional | | $115.22 | $126.86 | $188.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.18 / $198.27 / $299.08
| Facility | | $184.18 | $198.27 | $299.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.21 / $159.01 / $271.21
| Professional | | $152.21 | $159.01 | $271.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.72 / $126.72 / $214.48
| Facility | | $126.72 | $126.72 | $214.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.71 / $126.72 / $207.75
| Professional | | $107.71 | $126.72 | $207.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $153.75 / $267.51
| Professional | | $109.65 | $153.75 | $267.51 |