- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.56 / $86.78 / $197.87
| Facility | | $76.56 | $86.78 | $197.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.01 / $105.62 / $271.44
| Professional | | $84.01 | $105.62 | $271.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.23 / $156.46 / $228.18
| Professional | | $117.23 | $156.46 | $228.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.06 / $141.58 / $209.71
| Professional | | $109.06 | $141.58 | $209.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.13 / $137.16 / $175.47
| Facility | | $104.13 | $137.16 | $175.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.80 / $159.93 / $320.95
| Professional | | $117.80 | $159.93 | $320.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.24 / $153.68 / $259.32
| Professional | | $112.24 | $153.68 | $259.32 |