- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.71 / $113.37 / $235.29
| Facility | | $108.71 | $113.37 | $235.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.47 / $107.42 / $110.01
| Professional | | $105.47 | $107.42 | $110.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.85 / $116.71 / $132.22
| Facility | | $111.85 | $116.71 | $132.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.21 / $111.85 / $123.03
| Professional | | $103.21 | $111.85 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.06 / $119.23 / $138.83
| Facility | | $116.06 | $119.23 | $138.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.66 / $126.76 / $147.16
| Professional | | $116.66 | $126.76 | $147.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.41 / $129.41 / $137.19
| Professional | | $129.41 | $129.41 | $137.19 |