- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.67 / $179.35 / $216.09
| Facility | | $115.67 | $179.35 | $216.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.50 / $126.30 / $150.93
| Professional | | $108.50 | $126.30 | $150.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.06 / $188.63 / $307.45
| Professional | | $141.06 | $188.63 | $307.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.82 / $160.13 / $290.60
| Professional | | $105.82 | $160.13 | $290.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.06 / $154.46 / $285.45
| Facility | | $114.06 | $154.46 | $285.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.44 / $182.93 / $854.73
| Professional | | $138.44 | $182.93 | $854.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.72 / $171.39 / $316.68
| Professional | | $132.72 | $171.39 | $316.68 |