- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.28 / $121.06 / $127.89
| Facility | | $116.28 | $121.06 | $127.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.78 / $121.06 / $143.22
| Professional | | $91.78 | $121.06 | $143.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.71 / $147.79 / $345.25
| Facility | | $126.71 | $147.79 | $345.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.09 / $133.38 / $203.58
| Professional | | $109.09 | $133.38 | $203.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.07 / $139.07 / $139.07
| Facility | | $139.07 | $139.07 | $139.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.43 / $107.43 / $107.43
| Professional | | $107.43 | $107.43 | $107.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.08 / $155.16 / $245.52
| Professional | | $118.08 | $155.16 | $245.52 |