- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $151.36 / $154.88
| Facility | | $123.03 | $151.36 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $114.82 / $151.36
| Professional | | $77.62 | $114.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Professional | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $70.79 / $85.11
| Facility | | $60.26 | $70.79 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $123.03 / $229.09
| Professional | | $91.20 | $123.03 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $141.25 / $165.96
| Professional | | $109.65 | $141.25 | $165.96 |