- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.67 / $104.67 / $151.01
| Facility | | $100.67 | $104.67 | $151.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.75 / $104.67 / $145.97
| Professional | | $97.75 | $104.67 | $145.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.51 / $172.09 / $317.49
| Facility | | $112.51 | $172.09 | $317.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.80 / $100.80 / $117.02
| Professional | | $100.80 | $100.80 | $117.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.07 / $115.07 / $115.07
| Facility | | $115.07 | $115.07 | $115.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.07 / $115.07 / $115.07
| Professional | | $115.07 | $115.07 | $115.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.74 / $121.23 / $123.29
| Professional | | $102.74 | $121.23 | $123.29 |