- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.50 / $108.94 / $125.67
| Facility | | $102.50 | $108.94 | $125.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.72 / $103.33 / $139.78
| Professional | | $79.72 | $103.33 | $139.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.66 / $174.29 / $312.86
| Facility | | $168.66 | $174.29 | $312.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.51 / $127.78 / $164.72
| Professional | | $110.51 | $127.78 | $164.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.30 / $120.30 / $145.00
| Facility | | $120.30 | $120.30 | $145.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.26 / $120.30 / $196.50
| Professional | | $102.26 | $120.30 | $196.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.76 / $101.65 / $171.71
| Professional | | $77.76 | $101.65 | $171.71 |