- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.46 / $129.11 / $152.62
| Facility | | $114.46 | $129.11 | $152.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.86 / $114.47 / $152.63
| Professional | | $78.86 | $114.47 | $152.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.95 / $175.30 / $243.73
| Professional | | $91.95 | $175.30 | $243.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.35 / $152.63 / $218.26
| Facility | | $108.35 | $152.63 | $218.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.60 / $220.20 / $251.66
| Professional | | $120.60 | $220.20 | $251.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.40 / $194.03 / $228.27
| Professional | | $116.40 | $194.03 | $228.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.84 / $132.30 / $185.43
| Professional | | $105.84 | $132.30 | $185.43 |