- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.07 / $100.07 / $114.14
| Facility | | $100.07 | $100.07 | $114.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.26 / $102.01 / $145.50
| Professional | | $87.26 | $102.01 | $145.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.57 / $235.49 / $279.88
| Professional | | $196.57 | $235.49 | $279.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.51 / $217.38 / $303.98
| Professional | | $119.51 | $217.38 | $303.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.91 / $119.86 / $188.62
| Facility | | $90.91 | $119.86 | $188.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.64 / $210.41 / $702.61
| Professional | | $116.64 | $210.41 | $702.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.18 / $209.39 / $284.20
| Professional | | $109.18 | $209.39 | $284.20 |