- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.24 / $111.55 / $131.22
| Facility | | $83.24 | $111.55 | $131.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.15 / $104.96 / $137.87
| Professional | | $76.15 | $104.96 | $137.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.50 / $103.40 / $137.24
| Professional | | $77.50 | $103.40 | $137.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.87 / $88.67 / $137.19
| Facility | | $87.87 | $88.67 | $137.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.33 / $116.45 / $189.11
| Professional | | $83.33 | $116.45 | $189.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.05 / $135.15 / $207.44
| Professional | | $101.05 | $135.15 | $207.44 |