- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.53 / $135.29 / $515.64
| Facility | | $119.53 | $135.29 | $515.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.36 / $126.75 / $164.30
| Professional | | $117.36 | $126.75 | $164.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.24 / $131.03 / $137.93
| Facility | | $117.24 | $131.03 | $137.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.35 / $121.35 / $121.35
| Professional | | $121.35 | $121.35 | $121.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.72 / $110.72 / $117.36
| Facility | | $110.72 | $110.72 | $117.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.36 / $117.36 / $117.36
| Professional | | $117.36 | $117.36 | $117.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.19 / $131.35 / $164.07
| Facility | | $117.19 | $131.35 | $164.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.47 / $117.19 / $129.33
| Professional | | $116.47 | $117.19 | $129.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.36 / $117.36 / $136.94
| Professional | | $117.36 | $117.36 | $136.94 |