- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.47 / $175.20 / $175.72
| Facility | | $104.47 | $175.20 | $175.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.14 / $95.11 / $131.80
| Professional | | $78.14 | $95.11 | $131.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.00 / $110.34 / $169.59
| Professional | | $67.00 | $110.34 | $169.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.17 / $90.12 / $106.03
| Professional | | $72.17 | $90.12 | $106.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.84 / $107.30 / $132.74
| Professional | | $83.84 | $107.30 | $132.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.66 / $95.22 / $141.27
| Professional | | $73.66 | $95.22 | $141.27 |