- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.13 / $158.18 / $315.72
| Facility | | $131.13 | $158.18 | $315.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.23 / $125.39 / $171.06
| Professional | | $102.23 | $125.39 | $171.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.78 / $171.53 / $292.06
| Professional | | $105.78 | $171.53 | $292.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.15 / $149.44 / $300.44
| Professional | | $92.15 | $149.44 | $300.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.44 / $190.87 / $268.52
| Professional | | $154.44 | $190.87 | $268.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.88 / $373.58 / $794.75
| Professional | | $189.88 | $373.58 | $794.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.72 / $185.50 / $361.05
| Professional | | $118.72 | $185.50 | $361.05 |