- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.47 / $178.20 / $297.41
| Facility | | $104.47 | $178.20 | $297.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.18 / $104.47 / $223.07
| Professional | | $92.18 | $104.47 | $223.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.44 / $116.44 / $276.39
| Professional | | $116.44 | $116.44 | $276.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.74 / $155.05 / $291.26
| Professional | | $110.74 | $155.05 | $291.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.08 / $288.83 / $288.83
| Professional | | $138.08 | $288.83 | $288.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.68 / $169.82 / $311.32
| Professional | | $99.68 | $169.82 | $311.32 |