- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.31 / $101.63 / $123.81
| Facility | | $100.31 | $101.63 | $123.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.22 / $104.72 / $147.71
| Professional | | $83.22 | $104.72 | $147.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.45 / $203.85 / $380.90
| Facility | | $190.45 | $203.85 | $380.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.72 / $105.27 / $152.72
| Professional | | $104.72 | $105.27 | $152.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.22 / $112.22 / $112.22
| Facility | | $112.22 | $112.22 | $112.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.92 / $81.92 / $207.52
| Professional | | $81.92 | $81.92 | $207.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.06 / $95.02 / $143.13
| Professional | | $72.06 | $95.02 | $143.13 |