- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.08 / $106.55 / $124.75
| Facility | | $101.08 | $106.55 | $124.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.24 / $105.98 / $146.72
| Professional | | $87.24 | $105.98 | $146.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.33 / $207.14 / $359.96
| Facility | | $182.33 | $207.14 | $359.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.80 / $105.98 / $152.53
| Professional | | $105.80 | $105.98 | $152.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.82 / $121.82 / $124.20
| Facility | | $121.82 | $121.82 | $124.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.93 / $120.73 / $129.86
| Professional | | $88.93 | $120.73 | $129.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.36 / $94.19 / $141.16
| Professional | | $73.36 | $94.19 | $141.16 |