- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.36 / $203.68 / $473.34
| Facility | | $127.36 | $203.68 | $473.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.80 / $127.35 / $372.00
| Professional | | $86.80 | $127.35 | $372.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.58 / $130.41 / $228.53
| Professional | | $78.58 | $130.41 | $228.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.99 / $131.71 / $224.74
| Professional | | $100.99 | $131.71 | $224.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.02 / $119.57 / $177.60
| Professional | | $92.02 | $119.57 | $177.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.38 / $140.00 / $246.73
| Professional | | $128.38 | $140.00 | $246.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.12 / $122.49 / $243.87
| Professional | | $87.12 | $122.49 | $243.87 |