- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.59 / $145.58 / $185.51
| Facility | | $111.59 | $145.58 | $185.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.67 / $121.93 / $151.27
| Professional | | $106.67 | $121.93 | $151.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.77 / $169.77 / $169.77
| Professional | | $169.77 | $169.77 | $169.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.96 / $189.64 / $189.64
| Professional | | $128.96 | $189.64 | $189.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.47 / $164.95 / $186.43
| Professional | | $162.47 | $164.95 | $186.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.41 / $127.87 / $169.13
| Professional | | $100.41 | $127.87 | $169.13 |