- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.15 / $124.84 / $161.50
| Facility | | $124.15 | $124.84 | $161.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.63 / $134.44 / $190.46
| Professional | | $111.63 | $134.44 | $190.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.80 / $284.14 / $554.90
| Facility | | $231.80 | $284.14 | $554.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.74 / $139.22 / $194.22
| Professional | | $135.74 | $139.22 | $194.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.84 / $144.84 / $144.84
| Facility | | $144.84 | $144.84 | $144.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.73 / $105.73 / $269.63
| Professional | | $105.73 | $105.73 | $269.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.50 / $115.64 / $183.41
| Professional | | $94.50 | $115.64 | $183.41 |