- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.04 / $130.69 / $163.72
| Facility | | $104.04 | $130.69 | $163.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.31 / $131.87 / $155.15
| Professional | | $105.31 | $131.87 | $155.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.44 / $130.43 / $176.38
| Professional | | $128.44 | $130.43 | $176.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.31 / $146.46 / $205.74
| Professional | | $119.31 | $146.46 | $205.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.65 / $181.51 / $330.02
| Facility | | $141.65 | $181.51 | $330.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.42 / $127.95 / $170.98
| Professional | | $109.42 | $127.95 | $170.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.42 / $132.29 / $170.98
| Professional | | $109.42 | $132.29 | $170.98 |