- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.67 / $104.67 / $153.02
| Facility | | $100.67 | $104.67 | $153.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.75 / $115.13 / $172.50
| Professional | | $97.75 | $115.13 | $172.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.65 / $224.56 / $424.80
| Facility | | $124.65 | $224.56 | $424.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.60 / $97.60 / $102.74
| Professional | | $97.60 | $97.60 | $102.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.08 / $115.07 / $115.07
| Professional | | $60.08 | $115.07 | $115.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.67 / $109.90 / $153.02
| Facility | | $100.67 | $109.90 | $153.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.75 / $108.90 / $166.43
| Professional | | $97.75 | $108.90 | $166.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.74 / $123.14 / $127.02
| Professional | | $102.74 | $123.14 | $127.02 |