- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.53 / $112.87 / $116.17
| Facility | | $106.53 | $112.87 | $116.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.22 / $110.28 / $131.93
| Professional | | $95.22 | $110.28 | $131.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.75 / $123.94 / $170.47
| Professional | | $106.75 | $123.94 | $170.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.43 / $107.43 / $113.15
| Professional | | $107.43 | $107.43 | $113.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.33 / $131.57 / $188.98
| Professional | | $90.33 | $131.57 | $188.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.61 / $119.61 / $179.42
| Professional | | $119.61 | $119.61 | $179.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.16 / $137.41 / $240.58
| Professional | | $116.16 | $137.41 | $240.58 |