- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.36 / $133.62 / $184.48
| Facility | | $114.36 | $133.62 | $184.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.46 / $136.79 / $178.04
| Professional | | $120.46 | $136.79 | $178.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.85 / $111.85 / $183.60
| Facility | | $111.85 | $111.85 | $183.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.68 / $158.47 / $225.07
| Professional | | $110.68 | $158.47 | $225.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.62 / $219.62 / $1,382.00
| Facility | | $133.62 | $219.62 | $1,382.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.30 / $165.47 / $373.34
| Professional | | $125.30 | $165.47 | $373.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.30 / $165.47 / $363.83
| Professional | | $125.30 | $165.47 | $363.83 |