- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.51 / $115.05 / $211.80
| Facility | | $101.51 | $115.05 | $211.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.97 / $112.54 / $335.99
| Professional | | $74.97 | $112.54 | $335.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.47 / $102.99 / $156.04
| Professional | | $85.47 | $102.99 | $156.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.06 / $140.10 / $221.54
| Professional | | $88.06 | $140.10 | $221.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.53 / $143.41 / $202.52
| Professional | | $113.53 | $143.41 | $202.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.75 / $119.22 / $198.72
| Professional | | $77.75 | $119.22 | $198.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.51 / $126.64 / $179.27
| Professional | | $119.51 | $126.64 | $179.27 |