- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.70 / $108.28 / $207.75
| Facility | | $101.70 | $108.28 | $207.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.16 / $104.58 / $195.31
| Professional | | $81.16 | $104.58 | $195.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.24 / $113.22 / $142.02
| Professional | | $93.24 | $113.22 | $142.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.83 / $125.86 / $187.33
| Professional | | $88.83 | $125.86 | $187.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.70 / $101.70 / $286.64
| Facility | | $76.70 | $101.70 | $286.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.75 / $126.90 / $580.23
| Professional | | $97.75 | $126.90 | $580.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.44 / $120.18 / $170.17
| Professional | | $97.44 | $120.18 | $170.17 |