- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.77 / $114.21 / $134.36
| Facility | | $100.77 | $114.21 | $134.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.86 / $122.80 / $147.80
| Professional | | $105.86 | $122.80 | $147.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.31 / $321.33 / $378.03
| Professional | | $295.31 | $321.33 | $378.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.48 / $293.42 / $443.24
| Professional | | $226.48 | $293.42 | $443.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.36 / $142.93 / $403.08
| Facility | | $134.36 | $142.93 | $403.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.08 / $246.48 / $350.16
| Professional | | $120.08 | $246.48 | $350.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.78 / $253.89 / $350.16
| Professional | | $136.78 | $253.89 | $350.16 |