- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.37 / $98.36 / $102.70
| Facility | | $95.37 | $98.36 | $102.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.10 / $100.47 / $107.62
| Professional | | $90.10 | $100.47 | $107.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.13 / $2,377.90 / $3,067.69
| Facility | | $1,993.13 | $2,377.90 | $3,067.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.78 / $139.00 / $205.51
| Professional | | $111.78 | $139.00 | $205.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.89 / $106.89 / $109.07
| Professional | | $106.89 | $106.89 | $109.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.00 / $164.00 / $230.00
| Professional | | $117.00 | $164.00 | $230.00 |