- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.19 / $165.04 / $198.05
| Facility | | $154.19 | $165.04 | $198.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.37 / $165.16 / $184.71
| Professional | | $149.37 | $165.16 | $184.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.74 / $177.71 / $230.55
| Professional | | $140.74 | $177.71 | $230.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.22 / $214.47 / $306.27
| Professional | | $137.22 | $214.47 | $306.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.30 / $6.48
| Professional | | $1.30 | $1.30 | $6.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.30 / $1.30
| Professional | | $1.30 | $1.30 | $1.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.07 / $176.91 / $299.33
| Professional | | $121.07 | $176.91 | $299.33 |