- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.48 / $113.87 / $152.56
| Facility | | $100.48 | $113.87 | $152.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.65 / $117.02 / $154.56
| Professional | | $101.65 | $117.02 | $154.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.38 / $151.91 / $214.55
| Professional | | $117.38 | $151.91 | $214.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.79 / $220.41 / $342.88
| Professional | | $93.79 | $220.41 | $342.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.63 / $165.28 / $214.02
| Professional | | $163.63 | $165.28 | $214.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.48 / $113.87 / $152.56
| Facility | | $100.48 | $113.87 | $152.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.56 / $119.76 / $178.23
| Professional | | $102.56 | $119.76 | $178.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.39 / $182.76 / $236.33
| Professional | | $107.39 | $182.76 | $236.33 |