- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.43 / $126.36 / $151.63
| Facility | | $117.43 | $126.36 | $151.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.74 / $121.78 / $154.72
| Professional | | $100.74 | $121.78 | $154.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.77 / $140.38 / $229.54
| Professional | | $116.77 | $140.38 | $229.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.43 / $107.43 / $107.43
| Professional | | $107.43 | $107.43 | $107.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.79 / $187.31 / $330.27
| Professional | | $103.79 | $187.31 | $330.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.55 / $203.05 / $338.88
| Professional | | $165.55 | $203.05 | $338.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.34 / $108.17 / $137.68
| Professional | | $98.34 | $108.17 | $137.68 |