- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.57 / $139.43 / $184.17
| Facility | | $104.57 | $139.43 | $184.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.13 / $138.13 / $347.23
| Professional | | $102.13 | $138.13 | $347.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.68 / $306.88 / $377.21
| Professional | | $234.68 | $306.88 | $377.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.74 / $202.16 / $252.70
| Professional | | $143.74 | $202.16 | $252.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.83 / $153.04 / $239.96
| Facility | | $128.83 | $153.04 | $239.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.30 / $167.36 / $951.21
| Professional | | $110.30 | $167.36 | $951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.25 / $150.46 / $280.88
| Professional | | $120.25 | $150.46 | $280.88 |