- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $208.93 / $218.78
| Facility | | $120.23 | $208.93 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $190.55 / $346.74
| Professional | | $123.03 | $190.55 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $363.08
| Professional | | $120.23 | $186.21 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $501.19
| Facility | | $104.71 | $144.54 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $162.18 / $263.03
| Professional | | $112.20 | $162.18 | $263.03 |