- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.32 / $153.32 / $184.86
| Facility | | $153.32 | $153.32 | $184.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.81 / $152.52 / $226.57
| Professional | | $124.81 | $152.52 | $226.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.60 / $312.37 / $584.28
| Facility | | $273.60 | $312.37 | $584.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.06 / $163.91 / $223.80
| Professional | | $162.06 | $163.91 | $223.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.96 / $170.96 / $170.96
| Facility | | $170.96 | $170.96 | $170.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.80 / $124.80 / $303.93
| Professional | | $124.80 | $124.80 | $303.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.88 / $136.49 / $225.19
| Professional | | $106.88 | $136.49 | $225.19 |