- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $89.13 / $117.49
| Facility | | $81.28 | $89.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $102.33 / $144.54
| Professional | | $77.62 | $102.33 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $112.20 / $177.83
| Professional | | $102.33 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $107.15 / $173.78
| Professional | | $81.28 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $109.65 / $151.36
| Professional | | $70.79 | $109.65 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $138.04 / $162.18
| Professional | | $131.83 | $138.04 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $120.23 / $323.59
| Professional | | $87.10 | $120.23 | $323.59 |