- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.38 / $151.68 / $160.35
| Facility | | $140.38 | $151.68 | $160.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.88 / $123.87 / $165.16
| Professional | | $97.88 | $123.87 | $165.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.00 / $178.19 / $242.94
| Professional | | $110.00 | $178.19 | $242.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.43 / $118.77 / $140.57
| Professional | | $96.43 | $118.77 | $140.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.48 / $158.10 / $196.51
| Professional | | $126.48 | $158.10 | $196.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.26 / $143.93 / $207.56
| Professional | | $105.26 | $143.93 | $207.56 |