- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.96 / $148.13 / $274.26
| Facility | | $107.96 | $148.13 | $274.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.17 / $144.91 / $271.77
| Professional | | $88.17 | $144.91 | $271.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.51 / $376.14 / $392.13
| Facility | | $206.51 | $376.14 | $392.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.72 / $126.22 / $174.47
| Professional | | $96.72 | $126.22 | $174.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.02 / $152.94 / $277.76
| Professional | | $95.02 | $152.94 | $277.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.80 / $173.24 / $230.99
| Professional | | $126.80 | $173.24 | $230.99 |