- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.11 / $116.44 / $169.18
| Facility | | $98.11 | $116.44 | $169.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.08 / $109.44 / $221.07
| Professional | | $57.08 | $109.44 | $221.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.43 / $135.33 / $224.29
| Professional | | $100.43 | $135.33 | $224.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.17 / $94.06 / $113.84
| Professional | | $72.17 | $94.06 | $113.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.86 / $150.75 / $169.22
| Professional | | $84.86 | $150.75 | $169.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.84 / $126.72 / $167.04
| Professional | | $91.84 | $126.72 | $167.04 |