- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.61 / $142.36 / $167.49
| Facility | | $125.61 | $142.36 | $167.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.27 / $155.03 / $430.81
| Professional | | $116.27 | $155.03 | $430.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.16 / $136.16 / $235.57
| Professional | | $136.16 | $136.16 | $235.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.56 / $206.06 / $327.55
| Professional | | $121.56 | $206.06 | $327.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.44 / $167.29 / $272.35
| Professional | | $132.44 | $167.29 | $272.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.44 / $191.20 / $323.43
| Professional | | $128.44 | $191.20 | $323.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.07 / $147.94 / $211.61
| Professional | | $141.07 | $147.94 | $211.61 |