- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.74 / $118.03 / $652.42
| Facility | | $114.74 | $118.03 | $652.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $117.15 / $132.22
| Professional | | $108.47 | $117.15 | $132.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.70 / $193.56 / $306.88
| Facility | | $122.70 | $193.56 | $306.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $108.47
| Facility | | $102.33 | $102.33 | $108.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $108.47 / $108.47
| Professional | | $108.47 | $108.47 | $108.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.38 / $135.72 / $574.63
| Facility | | $110.38 | $135.72 | $574.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.28 / $115.84 / $365.52
| Professional | | $109.28 | $115.84 | $365.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.05 / $108.47 / $121.49
| Professional | | $103.05 | $108.47 | $121.49 |