- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $588.84 / $676.08
| Facility | | $102.33 | $588.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $144.54 / $338.84
| Professional | | $75.86 | $144.54 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $102.33 / $208.93
| Professional | | $74.13 | $102.33 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $162.18 / $229.09
| Facility | | $63.10 | $162.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $131.83 / $331.13
| Professional | | $52.48 | $131.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $109.65 / $117.49
| Professional | | $104.71 | $109.65 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $144.54 / $269.15
| Professional | | $89.13 | $144.54 | $269.15 |