- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.86 / $101.56 / $120.72
| Facility | | $80.86 | $101.56 | $120.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.86 / $102.62 / $120.72
| Professional | | $80.86 | $102.62 | $120.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.45 / $103.95 / $137.93
| Professional | | $100.45 | $103.95 | $137.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.17 / $115.04 / $175.30
| Professional | | $92.17 | $115.04 | $175.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.65 / $130.36 / $282.86
| Facility | | $108.65 | $130.36 | $282.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.81 / $93.26 / $133.99
| Professional | | $76.81 | $93.26 | $133.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.81 / $93.26 / $133.99
| Professional | | $76.81 | $93.26 | $133.99 |