- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.56 / $103.56 / $557.28
| Facility | | $103.56 | $103.56 | $557.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.08 / $103.56 / $136.86
| Professional | | $94.08 | $103.56 | $136.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.71 / $119.78 / $169.53
| Professional | | $101.71 | $119.78 | $169.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.92 / $141.62 / $163.38
| Facility | | $102.92 | $141.62 | $163.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.16 / $141.62 / $202.32
| Professional | | $101.16 | $141.62 | $202.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.01 / $123.17 / $123.17
| Facility | | $117.01 | $123.17 | $123.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.07 / $157.78 / $288.52
| Professional | | $105.07 | $157.78 | $288.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $111.28
| Professional | | $32.34 | $32.34 | $111.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.50 / $115.62 / $159.47
| Professional | | $97.50 | $115.62 | $159.47 |